•actical Points in the Management of Some of the 
Diseases of Children. 



..,. 



mm 



WmB^sm 



warn 






wssm 



iihbB 



R J 

£ 1 



WSSE& 



■ 



Warn 



WmmMm 






W$m 






mm 

WE£k 



WB%®&@mi 



Bv I. N. Love, M. D 




LIBRARY OF CONGRESS, 



¥T 



Shelf -»U.S.d 



UNITED STATES OF AMERICA. 



PRACTICAL POINTS 



Management of Some of the 
Diseases of Children. 




I. N. LOVE, M. D., 

President American Medical Editors' Association (1890'); President 

Pediatric Section of American Medical Association (1890'); 

President Mississippi Valley Medical Association (1887); 

Secretary Pediatric Section Ninth International 

Medical Congress ; Member American 

Pediatric Society; 

Member Board of Trustees of American Medical Association Journal ; 

Professor Diseases of Children, Clinical Medicine and Hygiene, 

Marion-Sims College of Medicine, St. Louis ; Consulting 

Physician City Hospital, St. Louis; Resident 

Assistant Physician City Hospital (in 

1872-73-7U), St. Louis; Editor 

Medical Mirror, St. Louis. 




1891 
GEORGE S. 



DAVIS, 



DETROIT, MICH. 



Copyrighted by 
GEORGE S. DAVIS. 

1891. 



X— Co 

V 



THIS LITTLE VOLUME IS DEDICATED 

To one of the most earnest, enthusiastic and honest workers that the 
American Medical Profession ever possessed, 

JOHN T. HODGEN, 

Whose life was the personification of Purity, a crystallization of Chastity 
and Charity; a constant inspiration to others to work and win— whose 
every act pronounced him the unselfish friend of humanity— the Young 
Doctor's Guide, Counsellor and Ardent Helper; whose every thought was 
to help others to help themselves, and keep all knowledge of his help 
from the beneficiary. 

Full many a year will come and go ere the Medical Profession of 
America has another more lofty and commanding figure. Those who 
knew him intimately and well were fortunate. There cluster about 
his personality, that was at times seemingly severe, though in fact 
ever calm, patient, strong, benignly firm, gentle and genial, many of 
the most tender and blessed memories connected with the life of 
THE AUTHOR. 



INDEX. 



Page 

Absorption of medicaments 52-53 

of quinine, mode of administration 52 

Administration of drugs to child, care in 41 

of teeth making materials 34 

Advantages of boiled milk 21 

^Esthetic medication 46-47 

Alcohol as a food 65 

how to administer 65 

in diphtheria 94 

Alimentary canal, clearing of 42-43 

Analysis of mother's milk 15 

Animal broths, value of 24-25 

Antipyretics in continued fevers 125-126 

Appearance of teeth, order of 33 

Arrangement and quality of utensils in sick-room 67 

Avoidance of cholera infantum 21 



B 

Baths, value of 7 

in typhoid fever 134-135 

Bathing, a treatment for fevers 43 

of children 7 

value of 43 

Beef cacao (Mosquera's) 66 

in typhoid fever 137 

Beef meal (Mosquera's) 25-66 

how to prepare for food 67 

palatibility of 66 

Benzoate of soda, a stimulant to secretions 74 

in diphtheria 95 

in tonsillitis 78-79 

Bichloride of mercury in diphtheria 95 



— VI — 

Page 

Boiled milk, advantages of 21 

value of as child's food 21 

Bromoform in whooping cough 116 

Broths, (animal,) value of 24-25 



C 

Care in diagnosis 42 

in selection and preparation of foods 55 

in selecting wet-nurse 17-18 

in selecting soaps 39 

of child during dentition 32 

of cord 28 

of nursing bottle 17 

of skin 40 

of wounds 29 

Catarrh, diagnosis and treatment of 70 

intestinal 69 

laryngeal 74 

prevalence of 69 

of respiratory tract 69 

Catarrhal fevers 69 

Calomel and ipecac in treatment of colds 72 

Cascara cordial in constipation 49 

Causes of cholera infantum 20 

of tetanus „. 27 

Chicken pox, diagnosis and treatment of . . , 112 

Child, care in administration of drugs to 41 

care of teeth in 55 

confidence of, to gain 3-4 

hygienic care of 56 

newborn, the 11 

food for 16 

liver of 13 

mouth of 12 

nourishment of 13 

toilet of 11 

treatment of mouth of 12 

susceptibility to opiates and quinine 41 

thirst in 15 

Children, bathing of. 7 

clothing of. 7 



— VII — 

Page 

Children, confidence of, to gain 2 

nursing of 14 

Child's doctor, the 2 

food, boiled milk as 21 

Chill, prevention of 7-8 

Chloroform, inhalation of in whooping-cough 115 

Cholera infantum, avoidance of 21 

causes of 20 

produced by cow's milk 19 

Clearing of alimentary canal 42^3 

Clothing of children 7 

Cold, calomel and ipecac in treatment of 72 

muriate of ammonia in 72 

necessity for prompt treatment of 71-72 

sequela? of 73 

taking 8-9 

treatment of 71 

Cold driEks, value of in measles 109 

Complications of scarlet fever 102 

Condom, use of in controlling epistaxis 141 

Confidence, of children, to gain 2 

Constipation, cascara cordial in 49 

Contamination of cow's milk 19 

Continued fevers 119 

antipyretics in 125-126 

care of glandular organs in 127 

control of temperature in 123 

diagnosis of 119 

Dover's powder in 128 

necessity for quiet in 128 

for sleep in 127 

pepsin cordiaHn 125 

tablet triturates of morphine in 128 

temperature in 122 

tranquillization of patient in 127 

treatment of 121 

varieties of 119 

Cord, care of 28 

management of 12 

Cow's milk, cholera infantum produced by 19 

contamination of 19 

use of sterilized 18 

Croup, membranous, diagnosis of 75 



— VIII — 

Page 

Croup, membranous, tartar emetic in 75 

treatment of 75 

necessity for keeping air moist in 76 

spasmodic, treatment of 74 

turpeth mineral (sub-sulphate of mercury) in . . 74 

Curative aid of Nature 41-42 



D 

Deficiency of mother's milk 14-15 

Dentition 31 

care of child during 32 

disturbances of 31 

order of appearance of teeth in 33 

treatment of eczema in 37 

Diagnosis and treatment of catarrh 70 

care in 42 

excretions in 5 

napkin in 5 

of chicken pox 112 

of continued fevers 119-120 

of diphtheria 86 

of German measles 110 

of measles 108 

of scarlet fever 101 

skin in 6 

tongue in .„ 5-6 

of tonsillitis 77 

of typhoid fever 131 

urine in 5 

of whooping cough 114 

Dietetic points 55 

Diphtheria 85 

as an accompaniment of scarlet fever 104 

alcohol in 94 

benzoate of soda in 95 

bichloride of mercury in 95 

deductions 97 

diagnosis of 86 

disinfection in 92 

history of 85 

nutrition in 92 

precautions against 91 



— IX — 

Page 

Diphtheria, stimulants in 93 

theories regarding 87-90 

treatment of 90-91 

turpentine in 97 

Disinfection in diphtheria 92 

Disturbances of dentition 31 

Doctor, the child's 2 

Dover's powder in continued fevers 128 

E 

Eczema, Hebra's ointment in 38 

importance of bathing in 39 

ointment of oxide of zinc in 38 

relief of itching in 38 

treatment of in dentition 37 

Elegance in medication 45 

Emesis, value of 43 

Enlarged tonsils 82 

hydriodic acid in 82 

removal of 83 

sequelae of 83 

Epistaxis 139 

causes of 139 

how to control 140 

use of condom in controlling 141 

Exanthematous fevers 99 

diagnosis and treatment of 99 

Excretions, value of in diagnosis 5 

Exercise, open air, necessity for 57 

F 

Feeding, regulation of 26 

Fever, scarlet 101 

complications of 102 

diagnosis of 101 

necessity for isolation in 102-103 

nephritis a complication of 103 

treatment of by bathing 43 

typhoid 130 

diagnosis of 131 

history of 130 



— X — 

Page 

Fever, typhoid, treatment of 133 

value of baths in 134-135 

Fevers, catarrhal 69 

continued 119 

antipyretics in 125-126 

care of glandular organs in 127 

control of temperature in 123 

diagnosis of 119-120 

- Dover's powder in 128 

necessity for quiet in 128 

sleep in 127 

pepsin cordial in 125 

tablet triturates morphine in 128 

temperature in 122 

tranquillization of patient in 127 

treatment of 121 

varieties of 119 

exanthematous 99 

cooling drinks and baths in 100 

diagnosis and treatment of 99 

Flowers in sick-room 67-68 

Fluid medicines, superiority of. 44 

Food, alcohol as a 65 

care in selection and preparation of 55 

child's, boiled milk as 21 

for newborn child 16 

malt liquors as .* 65 

selection of 59-60-61-62-63-64 

how to prepare 67 

G 

German measles 110 

Germicides, necessity for, in throat affections 80 

Glandular organs, care of, in continued fevers 127 

sympathy of 6 

H 

Hamamelis, extract of, in measles 109 

in scarlet fever 104 

in tonsillitis 81 

Hebra's ointment, in eczema 38 



Page 

History of diphtheria 85 

of typhoid fever 130 

How to administer alcohol 65 

quinine 50 

to control epistaxis 140 

to prepare beef meal (Mosquera's) for food 67 

foods 67 

Hot drinks inhibited in measles 108 

water as a therapeutic agent 45 

Hydriodic acid in enlarged tonsils 82 

Hygienic care of child 56 

measures ' 1 

precautions 58 

I 

Importance of bathing in eczema 39 

Infant, (See Child.) 

Infantile therapeutics 41 

Intestinal catarrh 69 

Introduction, general 1 

Irritation of skin in teething 36 

Isolation in scarlet fever, necessity for 102-103 

Itching in eczema, relief of 38 



L 

Laryngeal catarrh 74 

Liver of newborn child 13 

treatment of 13 



M 

Malnutrition, caused by bad hygiene 57 

Malt liquors as food 65 

Management of cord 12 

Measles . 108 

diagnosis and treatment of ." 108 

extract hamamelis in 109 

German, diagnosis and treatment of 110 

hot drinks inhibited in 108 

necessity for allaying skin irritation 109 

value of cold drinks in 109 



— XII — 

Page 

Medication by absorption 52-53 

elegance in 45 

Membranous croup 75 

tartar emetic in 75 

treatment of 75 

Milk as food, necessity for withholding 24 

boiled, advantages of 21 

cow's, contamination of 19 

producing cholera infantum 19 

sterilized 18 

mother's, analysis of 15 

deficiency of 14-15 

substitutes for 17 

peptonizing of 23 

sterilizing of 22 

Mineral salts, value of 25 

Moist air, necessity for, in treatment of croup 76 

Moral character of wet-nurse 17-18 

Morphine in continued fevers 128 

Mosquera's beef cacao 66 

beef meal 25-26 

Mother's milk, analysis of 15 

deficiency of 14-15 

substitutes for 17 

Muriate of ammonia, in colds 72 



N 

Napkin in diagnosis 5 

Nature's curative aid 41-42 

Nauseous medication to be avoided 48 

Necessity for germicides in throat affections 80 

for open-air exercise 57 

for withholding milk as food 24 

Nephritis, a complication in scarlet fever 103 

treatment of 103 

Newborn child, the 11 

food for 16 

liver of 13 

mouth of 12 

nourishment of 13 

toilet of 11 

treatment of mouth of 12 



Page 

Nose-bleed 139 

causes of 139 

how to control 140 

Nourishment of newborn child 13 

Nursing bottle, care of 17 

of children 14 

Nutrition in diphtheria 92 



Open-air exercise, necessity for 57 

Opiates, susceptibility of child to 41 

Order of appearance of teeth 33 

Oxide of zinc ointment in eczema 38 



Palatibility of beef meal (Mosquera's) 66 

Pancreatic extract 24 

Pathological condition during teething 35 

Pepsin cordial, an adjunct to quinine 51 

in continued fevers 125 

in scarlet fever 104 

Peptonizing of milk 23 

Personal disinfection in scarlet fever 105 

Physical condition of wet nurse 17-18 

Precautions against diphtheria 91 

Prevalence of catarrh 69 

Prevention of chill 7-8 

of tetanus 27 

Q 

Quiet, necessity for, in continued fevers 128 

Quinine, external application for absorption 52 

formulae for administration of 51 

how to administer 50 

susceptibility of child to 41 

R 

Regulation of feeding 26 

Relief of itching in eczema 38 

Removal of too early appearing teeth 35 

Respiratory tract, catarrh of 69 



S Page 

Scarlet fever 101 

complications of 102 

diagnosis of 101 

diphtheria an accompaniment of 104 

extract hamamelis in 104 

necessity for isolation in 102-103 

nephritis a complication of 108 

pepsin cordial in 104 

personal disinfection in 105 

treatment of 106 

Sequelae of cold 73 

Sick room, arrangement of utensils in 67 

flowers in 67-68 

Simple sterilizer 22 

Skin, the 36 

care of 40 

in diagnosis 6 

irritation, necessity for allaying 109 

of in teething 36 

Sleep, necessity for in continued fevers 127 

Soaps, care in selecting 39 

Spasmodic croup, treatment of 74 

Sterilized cow's milk 18 

Sterilizer, simple 22 

Sterilizing of milk 22 

Stimulants in diphtheria * 93 

Substitutes for mother's milk 17 

Superiority of fluid medicines 44 

Susceptibility of child to opiates 41 

to quinine 41 

Sympathy of glandular organs 6 

T 

Tablets of tartar emetic 76 

Tablet triturates morphine in continued fevers 128 

Taking cold 8-9 

Tartar emetic in membranous croup 75 

tablets of 76 

Teeth, care of in child 55 

too early appearance of 35 

making materials, administration of 34 



Page 

Teething, pathological conditions during 35 

Temperature, control of in continued fevers 123 

in continued fevers 122 

Tetanus, causes of 27 

neonatorum 27 

prevention of 27 

Theories regarding diphtheria 87-90 

Thirst in child. . . 15 

Throat affections, germicides in 80 

Tongue in diagnosis 5-6 

Tonsils, enlarged 82 

diagnosis and treatment of 82 

hydriodic acid in 82 

"removal of 83 

sequelae of 83 

Tonsillitis 77 

diagnosis of 77 

extract hamamelis in 81 

treatment of 78 

Too early appearance of teeth 35 

Tranquillization in continued fevers 127 

Treatment of chicken pox 112 

of cold 71 

of continued fevers 121 

of diphtheria 90-91 

of eczema in dentition 37 

of German measles * 110 

of liver 13 

of measles 108 

of nephritis 103 

of scarlet fever 106 

of spasmodic croup 74 

of tonsillitis 78 

of typhoid fever 133 

of whooping cough 114-115 

Trismus 27 

Turpentine in diphtheria 97 

Turpeth mineral (sub-sulphate of mercury) in croup . . 74 

Typhoid fever 130 

beef cacao (Mosquera's) in 137 

diagnosis of 131 

history of 130 

treatment of 133 



— XVI — 

Page 

Typhoid fever, value of baths in 134-135 

Tyrotoxicon in cow's milk 19 

producing cholera infantum 19 



U 

Urine, in diagnosis 5 

Utensils, arrangement of in sick-room 67 



Vaccination 117 

care after 118 

procedure in 117 

time for 117 

Value of animal broths 24-25 

of baths 7 

of emesis 43 

of mineral salts . . 25 

Varieties of continued fevers 119 



W 

Water, hot, as a therapeutic agent 45 

value of drinking ^ 44-45 

warm, as nourishment 14 

"Wet nurses 17 

care in selecting 17 

moral character of ' 17-18 

physical condition of 17-18 

Whooping cough 113 

bromoform in 116 

diagnosis of 113 

inhalation of chloroform in ' 115 

seriousness of 114 

treatment of 114-115 

Witch hazel in tonsillitis 78 

Wounds, care of 29 



PREFACE. 

Never in the history of the world has there been as much 
brain-work upon the part of every class and condition of men 
in behalf of children as now. This is, indeed, the children's 
age. 

Art, literature, mechanical ingenuity, and every possible 
field of work have been directed toward the improvement, the 
amusement, and the comfort of the children, and it is high time 
for doctors to be aroused to a keener interest in them. 

The object of this little volume is simply to group together 
a number of practical points pertaining to various disturbances 
of childhood which have come under the direct observation of 
the writer. That which is said here is a mingling of facts 
gleaned from the works of other men, and bedside observation, 
both in pri rate practice, hospital and dispensary work. During 
the past twenty years the writer has had a field of work in the 
City of St. Louis, which has been at least a varied one, the 
first five years being connected with the City Hospital, City 
Dispensary, and other institutions. The chief and last part of 
this period has been devoted to private practice. 

There is much difference in the character of the diseases 
which are observed among the poorer classes of a large city 
and among the well-to-do. In the former instance, the chief 
troubles are those dependent upon bad air, bad food and 
insufficient clothing. Among the latter, the variations from 
the standard of health are largely due to improperly selected 
food, over-feeding, and congestive troubles dependent upon 
taking cold, being caused in the majority of cases by over- 
heated homes, insufficient clothing and careless exposure to 
the elements. The exanthematous diseases affect all classes, 



but they are more serious and more fatal among the unfor- 
tunate poor. The opinions of every writer should be carefully 
considered, for it would add much to the correctness of our 
conclusions, if we could determine the particular field of 
work in which the writer has been engaged. Views which are 
based entirely upon a hospital experience, or upon a work 
among the pauper element, necessarily vary much from those 
of an observer whose work is among the upper "400" of a 
great city; or from the opinions of him whose parish happens 
to be out in a section of country far removed from the city, 
where every breeze that comes from the various points of the 
compass carries with it health, life, and force, and where the 
facilities for good food are in abundance. 

The writer trusts that the views herein presented will at 
least be accepted in the spirit in which they are given. He is 
conscientiously anxious to advance the interests and arouse 
the thought of the profession in the direction of the importance 
of pediatrics. If this little book, intended for the "leisure 
hour," aids in the accomplishment of this end, it will not have 
been written in vain. 



GEN ERAL. 

In managing the diseases of children, we shall have 
gained much if we recall the fact that we can cure 
the diseases of babyhood better by preventing them 
than in any other way. 

We should make it the object of our lives to teach 
the parents of the children under our care that an 
indefinite amount of prevention is worth more than 
an indefinite amount of cure. Every day's sickness 
checks the proper development of the child, aiding 
in the direction of a delicate organization rather than 
a strong one. 

There can be no wound without a subsequent scar, 
nor can there be a day's illness without its effect 
upon the child. 

This being so, we should emphasize to the mother, 
in tones of thunder, the thought that nothing which 
will tend in the direction of preventing disease is 
trivial. We should run the risk of being charged 
with being cranks and riding hobbies if need be, 
rather than become neglectful or allow the parent to 
be neglectful of the health of the child. In a general 
way we are safe in saying that nearly all the diseases 
of early life may be avoided if constant, unremitting 
care be given the child. Proper hygienic measures ; 
cleanliness, keeping open the secretions, the anatom- 
1 



ical sewers so to speak of the little bodies, from the 
very day of their birth on through each and every 
day of their lives ; selection of diet, proper instruc- 
tion as to the time of eating, protection against chill- 
ing of the surfaces, clothes proper for each and every 
season, all are of vital importance. 

If we have faith that religious care in these direc- 
tions will be followed by success and the health of 
the children, and if we infect the parents under our 
care with our belief, much will have been accom- 
plished. 

One of the first essentials to the proper manage- 
ment of the diseases of children is to have the com- 
plete confidence of the children themselves. If we 
have their confidence, our presence does not disturb 
them, but has the opposite effect, and we are better 
able to secure a full knowledge of their case. Every 
possible effort should be made to so influence them 
as to reach their tender side and thus have presented 
to us a clear undisturbed picture. 

We should establish the habit of mingling with 
children, and if we do not possess a natural fondness 
for them, we should endeavor to develop it. We 
should constantly study children, their habits, tastes 
and peculiarities in health if we hope to cope with 
them in disease. I am strong in the belief that 
(other things being equal) a man's interest in chil- 
dren is greatly increased by his possession of them. 
The child's doctor as a rule, should be a father. 



— 3 — 

By taking this position, I do not mean to oppose 
the treatment of children by bachelor doctors or 
childless fathers, for often I have seen these latter 
much fonder of children than many parents of my 
acquaintance, yet the fact remains that constant asso- 
ciation with children develops a knowledge of them. 

Having learned to know children in health, being 
familiar with their peculiarities and idiosyncrasies 
when well, we are the better able to judge of them 
when they become the victims of disease. 

In making our examinations of a child, if not 
already acquainted with him, we should be particu- 
larly careful to make our approaches gently, in fact 
if there is one word that I would emphasize in con- 
nection with managing children, it is "gentleness," 
and if you couple with that word another one, viz : 
" firmness," equally important, we have a pair which 
will enable us to accomplish much. 

A "gentle firmness" is one of the first requisites 
of a good parent, so also it is of a good child's doctor. 
A never varying patience, a persistent perseverance, 
a loving interest in the child, an ability to impress it 
with the fact that you are its friend are the first 
essentials. 

Children, like dogs, intuitively know their friends, 
and if a physician has not and cannot cultivate love 
for children, he ought to be honest enough to refuse 
to attend them. 

Of course I would not make the point that these 



— 4 — 

qualifications referred to are superior to a scientific 
knowledge of the etiology, pathology and proper 
treatment of the diseases of children, but I do believe 
that the possession of these latter qualifications will 
not bring success if the others be absent. 

I recall a case which came under my observation 
some years ago, where a harsh, rough, uncouth, un 
kind physician was called to see a fretful, peevish 
child and instructed the mother, in spite of the con- 
ditions present, to punish the child for his ugliness of 
disposition. The child was thrown into convulsions 
later and the surprising part of it is that the result 
was not fatal. The doctor in the case should have 
been put under treatment himself and another atten- 
dant should have been called. Suppose we are called 
to a child with fever, a disturbed nervous system, a 
rapid pulse, a heart acting tumultuously, if we are 
not able to command the confidence of the child, we 
are certainly at a great disadvantage. Our presence 
annoys and antagonizes him and .aggravates all of 
the symptoms present; if, however, we can reach 
the better side of the child, if our knowledge of baby 
nature be sufficient, we can soon have an opportunity 
for studying the case perfectly. Take for instance 
the question of securing the temperature by means of 
the fever thermometer, if we approach a child abruptly 
or awkwardly before we have secured a proper know- 
ledge of the degree of fever in the case, we will have 
thoroughly " rattled " the little patient. If we under- 



— 5 — 

stand him however, and approach him correctly, hav- 
ing his confidence, we will soon secure not only the 
temperature but many points valuable in the making 
up of our diagnosis. 

Remember, if we frighten and demoralize our 
patient, all symptoms are intensified. 

We should secure a knowledge of the excretions ; 
one of our first inquiries should be as to the nature 
of the evacuation from the bowels. If the napkin 
has not been preserved, we should impress upon the 
parent the importance of saving the last action from 
the child and the napkin before our next visit. Noth- 
ing will so clearly indicate the condition of the ali- 
mentary canal as the evacuation from the same. If 
the discharges from the bowel be frequent and unsat- 
isfactory, with straining efforts, local irritation, par- 
ticularly of the lower bowel, is indicated. If the urine 
be high colored, the napkin darkly stained by it, it is 
suggestive of fever. The appearance of the tongue 
is of vital importance. If the tongue be broad, too 
large for the cavity which contains it ; if there are 
indentations upon the sides occasioned by the teeth 
pressing upon the same, with more or less pain over 
the right hypogastrium, we have evidence of an inac- 
tive liver. If there be on the tongue a heavy coat- 
ing with red points and edges, we have evidence of 
an inactive state of all the secretions and marked 
gastro-intestinal disturbance, or else, if a continued 
fever be present, we have symptoms pointing towards 



— 6 — 

typhoid fever. We should bear in mind that the 
tongue is expressive of the conditions of the alimen- 
tary tract in its entirety, the mouth being the " port 
of entry " to the great gastro-intestinal canal. If 
we have an active secretion upon the part of the 
stomach and the rest of the glands of the intestinal 
canal, the tongue will indicate it; if, however, the 
tongue be heavy, swollen and gorged, it is typical of 
the same condition beyond. We are safe in judging 
a "road-way" by the appearance of the "gate-way" 
to the same. 

Another point: If the skin be dry, inactive, 
shrunken, it is in itself expressive of the condition 
of the system at large; indeed, we should remember 
that the skin and the alimentary canal are each a 
continuation of the other. The entire tissues of the 
body are contained within a closed sac, the outer 
portion of which is skin, the inner layer of which is 
the mucous lining of the alimentary canal. The 
only difference between the lining membrane of the 
alimentary canal and the cutaneous covering of the 
body is one of degree, the epithelial layer of the skin 
being thicker and heavier. 

Not only do the skin and the lining of the alimen- 
tary tract sympathize one with the other, but the 
entire glandular system of the body acts in harmony. 
The liver, the spleen, and the various glandular 
organs are active or inactive just in proportion as 
the skin and its appendages and the internal lining 



of the body, as expressed by the tongue, are active 
or the reverse. An important thing we should bear 
in mind in connection with babyhood is the proper 
clearing out every day of the bowels, as well as see- 
ing to it that the skin is carefully washed. We 
should instruct the parent of the child to protect the 
surface against sudden or excessive chilling by a 
lighter or heavier grade of flannel, according to the 
season, the year through. Fortunately now the 
manufacturing guild has directed its attention to- 
wards the furnishing of all-wool, regular made, soft, 
elegant grades of flannel, suited to the season. 
Three grades are presented: the heavier for mid- 
winter, the medium for spring and fall, and the 
lighter grade for summer. There can be no doubt 
nature intended that a non-conducting covering 
should be furnished all animals. Particularly the 
chest and bowels of the child should be protected at 
all times. I feel that we are neglectful of our duty 
if we fail to impress upon parents the necessity of 
the child wearing not only an all-wool undershirt 
summer and winter, but also to direct that it should 
have the bowels covered with a flannel bandage, by 
which precaution we assist in the prevention of the 
chilling of the abdominal surf aces by which the blood 
is driven to the internal organs, causing impaired 
digestion, congestion or inflammation. If we remem- 
ber that a very large percentage o.f the deaths in the 
earlier years of life are caused by diseases of the 



respiratory system, due to the so-called colds, depend- 
ent upon the chilling of the surface, the importance 
of this course can be appreciated. In addition to the 
great mortality occasioned by diseases of the respira- 
tory system, dependent upon taking cold in early life, 
numerous deaths result from the same cause affecting 
the abdominal organs. 

I know I am safe in saying that ninety per cent, 
of all the children who die under three years of age, 
die from disturbances of the alimentary canal, the 
digestive system, or respiratory apparatus, dependent 
in the majority of cases upon the chilling of the sur- 
faces. 

It is a popular idea that the chief danger to chil- 
dren during the summer months is the excessive 
heat; that the various diseases of the alimentary 
canal are dependent upon the effects of the heat. 
This is certainly true to a very considerable extent, 
the heat producing that general depression conducive 
to sensitive nerve centers which superinduces internal 
congestions, disturbed digestion, etc. At the same 
time there is danger of the child taking cold even in 
the hottest weather. 

In midsummer instructions are often given mothers 
to place the child, with only the lightest slip of mus- 
lin upon it, in a position where it can get fresh air. 
Time and again I have found these little sensitive 
plants in the hot days of July and August with 
nothing on them except the little slip referred to, in 



some shady place where a strong draft would blow 
upon them. I have even found them placed in the 
cellar on account of the coolness there, the whole 
thought seeming to be to keep the child cool. I 
wonder that some of the ignorant mothers have not, 
as a result of the constant preaching which they 
have received upon this subject, placed the little 
ones in the refrigerator. 

I have found children dangerously ill with conges- 
tion of the stomach and bowels dependent upon cold 
received in the manner suggested. There is almost 
as much danger to the little one from "taking cold" 
in hot weather as there is from "taking heat." We 
should provide for a uniform temperature, and impress 
upon the parents the absolute necessity of the child 
being guarded against a draft. 

The thought has been thrown out that in treating 
children we labor at a disadvantage, our hands being 
tied on account of the fact that the child cannot give 
us a history of his case, and that there is much light 
which we lose in consequence of this. But, take it 
all in all, I am strong in the belief that we have a 
decided advantage in the managing of the diseases 
of children over and above those of adult life. 

Though the child may not be able to verbally pre- 
sent to us much in the way of information, probably 
we are better off for that, for many times the phy- 
sician is misled by the remarks of the patient. 
A child never pretends (except in rare instances 



— 10 — 

during school life possibly). So in earlier childhood, 
in infantile life, we generally have presented to us a 
correct picture, the true story. Nothing is withheld, 
nothing exaggerated, things are exactly as they seem, 
and the gravity of the case is unaffected by over- 
anxiety on the part of the child, by worrying, by the 
indulgence of gloomy anticipations, by the burdens 
which naturally belong to adult life. If we cultivate 
the habit of carefully studying the symptoms as they 
are presented to us, we will soon find ourselves more 
promptly able to make a diagnosis than when called 
to an adult. 



THE CHILD IMMEDIATELY AFTER BIRTH. 

It is too frequently the custom for the newborn 
infant to be turned over promptly to the tender 
mercies of the "Sairey Gamp" of the sick room, and 
all the energies of the medical attendant to be 
directed to the mother. 

This is a mistake; in the first place the watchful, 
thoughtful mother can but feel that the dearest object 
of her life is being neglected and this in itself is de- 
pressing to her, so for the good of the mother the 
physician should pay due attention, at every visit, to 
the child, but primarily, for the good of the child, the 
doctor should give it careful attention from the very 
moment of its birth. 

I should not think of giving instructions as to the 
toilet of the newborn child for the reason that this 
little work could not properly take up that subject. 
The text books on Obstetrics all have instructions 
upon this point, yet, at the same time, they do not 
sufficiently impress upon the reader the fact that he 
should give scrupulous attention to the babe. 

We all know the importance of placing the child 
upon its right side immediately after birth with a 
view of favoring the closure of the foramen ovale; of 
the proper cleansing of the child; of the proper dress- 
ing of the cord. In this latter connection I would 



— 12 — 

suggest that we emphasize in our minds the import- 
ance of dressing the cord antiseptically, the same as 
we would make any surgical dressing; the bathing of 
the same in corrosive sublimate solution, one part to 
a thousand would be in order, followed by wrapping 
in corrosive sublimate lint. With such dressing sup- 
puration can be completely ruled out, and we all 
know that by these precautions (since the demon- 
stration of the bacillus tetanus) tetanus neonatorum 
is also ruled out. 

The nurse should be instructed carefully as to the 
proper manner of washing the little one's mouth. 
Coarse, rough cloths have frequently been used and 
too much muscular effort directed to the delicate 
mucous lining of the mouth and tongue and denuda- 
tions of the mucous membrane have frequently been 
produced. 

A soft rag or a small piece of absorbent cotton 
wrapped about the finger answers well, and a mild 
antacid lotion should be used, nothing being better 
than the following: 

3. 



Sodii Biboratis, 


3ii. 


Fl. Ext. Pinus Canadensis, 


5ss. 


Glycerin, 


5ss. 


Aquae Rosse, 


|iii. 



M. Sig. : Use as a mouth wash night and morning. 

The nurse should use no force in the process. 
Immediately after birth the child should be given 
for twenty-four hours the following: 



— 13 — 

I£. Hydrarg Chi or. Mit. gr. i. 

Sodii Bicarb., 

Sacch. Lac, aa grs. x. 

M. ft. ch. No. xx. 
Sig. : One powder every two hours. 

By this powder we gently stimulate the secretions 
of the alimentary canal, the activity of the liver is 
aroused, fermentation in the stomach and bowels is 
prevented and an antiseptic condition therein is pro- 
duced. 

When we remember that in the newborn child the 
liver is larger, in proportion to the body, than it will 
ever be again, that there is an engorged condition of 
the excretory organs and that the alimentary canal is 
filled with accumulated secretions, we can appreciate 
the importance of a remedy which will at once clear 
out the system and make way for the proper reception 
of food on the part of the food tract. 

I am sure that this course not only favors the 
cleansing out of the alimentary canal, but tends to 
the prevention of jaundice, and arouses activity in 
the entire glandular system of the child. 

It helps in the direction of better digestion, of 
better rest, inasmuch as the fermentative condition 
of the alimentary canal is largely productive of the 
colics so frequent in the newborn. 

We should now turn our attention to the proper 
nourishment of the child. 

First of all we should instruct the nurse to give 
freely of warm water, two or three or four teaspoon- 



— 14 — 

fuls at a time for the first few hours. This form of 
nourishment (and warm water is a nourishment) 
will probably be sufficient for the first twelve hours, 
but in some cases we need to give more. 

Of course it goes without saying that the child 
should immediately after birth be placed to the 
mother's breast, as her best interest is thus subserved, 
as well as that of the child. 

The withdrawal of the accumulation within the 
breast stimulates a more active contraction of the 
uterus, and the secretion of the breast taken by the 
child aids in clearing out its alimentary canal. 

We hear much regarding the duty of mothers in 
nursing their own children. I have rarely found, be 
it said to the credit of maternity, a mother who was 
not anxious to nourish her child. During the past 
twelve years I have been fortunate in having a prac- 
tice among the very best element of a large city. 
Many society women, many women who might be 
considered light and frivolous, and yet with one 
exception I have found them all anxious to do their 
duty to their child, so that I feel that as a rule we 
shall have the earnest co-operation of the mothers in 
nursing their children. 

If the mother seems short of milk, we should not 
be too easily discouraged, and should persistently 
feed her with a view to the developing of her milk- 
giving powers. At the same time we must remember 
that under the existing conditions of society and 



— lo- 
calization there are many women who are congenit- 
ally imperfect in this direction, and we should not 
fail to promptly make up all deficiency upon the part 
of the mother. 

Scores and scores of times I have had children 
come under my observation who had been practically 
starved to death the first three or four months of 
their lives by earnest, anxious mothers, who thought 
they were nursing their children and giving proper 
nourishment to them. 

The little one may work earnestly, energetically 
and persistently and get but little. He cries ever and 
anon and at once is dosed by the nurse, or possibly 
by the anxious mother, who is ignorant of the fact 
that her child is hungry. Among the ignorant, un- 
fortunately, some "soothing syrup" is apt to be 
brought into requisition. 

The baby is frequently thirsty, and should be given 
freely of water instead of being placed at the breast; 
but if there be a dearth of secretion in the breast, the 
child is probably kept at the same a considerable 
part of the time pulling away for dear life for what 
he does not get, his mother weary and worn out, and 
he vexed and irritated, and righteously so, too, for 
the reason that he is w r orking for a living and not 
getting it. All these things should impress upon us 
the importance of now and then making more careful 
investigations. Analyze the mother's milk, and make 
frequent examinations of the condition of the breast. 



— 16 — 

Have the child refrain from nursing for a given 
length of time, and observe if there is any accumula- 
tion. Insist upon regularity in feeding but there is 
no particular harm done if the child be changed from 
his food. 

We are safe in taking the position that as long as 
there is nothing in the composition of the food in it- 
self objectionable, and if the food be in a form digest- 
ible it is safe to be used. We need not fear chang- 
ing from one food to another that is we need not fear 
the result if we take a child from the mother's breast, 
say for half a day or a day, and give it temporarily 
some substitute for its natural food. 



SUBSTITUTES FOR MOTHER'S MILK. 

On substituting some other food for the mother's 
milk it may be necessary to give the artificial food 
every alternate feeding; in other words it may be only 
a partial substitution. 

Let us save the mother's breast milk and encourage 
her milk-giving powers, for in case of illness on the 
part of the child when light diet is allowable this 
supply is a Godsend. The child is soothed and com- 
forted, and there is much in that. 

For the first month or two the child should not be 
fed oftener than once in two hours, the interval may 
then be lengthened to two hours and a half. 

Do not forget that the nursing bottle should be 
plain and simple, — it is easier to clean. For the same 
reason the nipple should be the block rubber variety. 
No tubular affair should be allowed. 

The use of several bottles, ample cleaning, airing 
and sunning should be insisted upon. 

Wet-Nurses. — Of course it goes without saying 
that as a substitute for mother's milk, some other 
mother's milk is preferable; in other words a wet- 
nurse should be engaged, if one can be secured whom 
we know to be in good physical condition, with no 
taint upon either physical or moral character. Bet- 
ter by far that the child should run the gauntlet of 



— 18 — 

some other forms of food, or even die, than that a wet- 
nurse be brought in the family whose qualifications 
render her somewhat of the nature of a moral leper. 

Parents have a divided duty, a duty to the home in 
its completeness, a duty to their other children as 
well as to the infant. 

Taking one consideration with another, in the 
majority of instances we are safe in ruling out of the 
family the wet-nurse; besides many families cannot 
aiford the luxury. 

In the selection of a wet-nurse invariably insist 
that a clear bill of health be presented and also evi- 
dence of the possession of a good moral character 
and a reasonably kind disposition. 

Impress upon the mother, however, in employing a 
wet-nurse the thought that there need be no special 
fear in the matter of changing foods, or changing wet- 
nurses. Indicate at once to the nurse employed com- 
plete independence of her. If the reverse course be 
pursued the naturally tyrannical nature of the brood 
will be apt to manifest itself. Details as to the quali- 
fications of the wet-nurse need not be presented. 

I maintain that the little one can have a change of 
food without running any very great risk, if the 
severest care be exercised. 

If a wet-nurse is not available (other things being 
equal), the milk from a good, healthy cow is to be 
preferred s and before being used it should be com- 
pletely sterilized. 



— 19 — 

There are many writers who take the position that 
cow's milk is the only food for infants where wet- 
nurses are not available, but the same objections some- 
times apply to cow's milk as to wet-nurses. 

The difficulty of knowing the condition of the cow 
from whom the milk is taken, as to the cleanliness of 
those who have cared for the milk, and the difficulty 
also of impressing upon the members of the house- 
hold the fact that milk is more readily polluted by 
its environment than any other article of diet, pre- 
sents many objections to its use, as also the addi- 
tional facts that it absorbs atmospheric impurities; 
that it readily ferments and sometimes develops with- 
in itself poisonous properties. 

In 1884 Prof. Victor C. Vaughan, of the University 
of Michigan, isolated an active principle from poison- 
ous cheese, which he named tyrotoxicon. Later he 
found the same principle in impure milk, ice-cream, 
and other articles of food in which such milk formed 
a part. In experimenting with the poison, it was 
found that its action on the lower animals produced 
the phenomena of cholera infantum. The symptoms 
and the post-mortem appearances were identical. 
From this it is easy to understand the prevalence of 
cholera infantum among the very poor, where fresh, 
wholesome milk is almost unknown. 

We have in this discovery an explanation of the 
many so called obscure cases of poisoning from pic-' 
nic ice-cream. In many of these parties there have 



— 20 — 

been large numbers taken down suddenly with all 
the symptoms of acute poisoning from arsenic or 
other active irritants. 

There can be no doubt that the tyrotoxicon of 
Vaughan is the casus belli in the majority of these 
cases. Dr. Vaughan, after a long series of laboratory 
experiments, demonstrated that normal milk infected 
with a small portion of poisoned milk and kept a few 
hours at the temperature of the body, rapidly be- 
comes poisonous in its entirety. 

Dr. W. D. Booker, of Johns Hopkins University, 
has done much active work in the laboratory in the 
direction of demonstrating the micro-organisms which 
are at the bottom of much of the trouble of the ali- 
mentary canal of infants suffering from " summer 
diseases." 

There never was yet a case of cholera infantum 
that had not a preliminary history of gastro-intestinal 
disturbance of a mild character, usually lasting from 
two to three days prior to the acute attack. Of 
course, exceptionally, there can be sudden attacks of 
cholera infantum just as there may be of cholera- 
morbus in adults, produced by an excessive amount 
of undigested food, but the majority of cases present 
a preliminary history of a mild intestinal war prior 
to the more acute attack. Observers who have had 
an opportunity of studying the subject know that 
when cholera is present there is generally a history 



— 21 — 

of choleraic diarrhoea preceding the acute attack of 
cholera. 

If the proper diet be selected in these cases during 
the cholera times and if the proper check be placed 
upon the disturbance in the alimentary canal, the 
majority of cases of cholera would be avoided. For 
the same reason, we would impress upon the mothers 
and the attendants of the children under our care 
the fact that in summer or winter if the mild dis- 
turbances of the bowels of the child be properly 
cared for, cholera infantum will in the majority of 
cases be ruled out altogether. 

In the managing of these disturbed digestions and 
more serious intestinal riots, we should bear in mind 
Taughan's tyrotoxicon, and we will often find it best 
to withdraw all milk diet for a time. 

We have for centuries rapidly advanced in our 
development of proper food for adult life, and the ad- 
vancement of civilization has demonstrated to us that 
nearly all food which is properly prepared is cooked, 
and yet not until recently did we realize that milk 
should be no exception to the rule. There can be no 
doubt but that the boiling process renders the milk 
more digestible. The curd of the milk which is 
formed in the stomach after drinking appears in finer 
particles, is more broken up, and is of course more 
approachable by the gastric juice. 

The boiling of milk also has an additional advan- 
tage, in that it destroys the possibility of tubercular 



— 22 — 

infection, it having been demonstrated that the milk 
of cows suffering from tuberculosis may transmit 
that disease to those who partake of it. As has been 
suggested when citing the cases of acute gastroin- 
testinal disturbances aroused by picnic ice-cream, 
dependent upon the presence of the cheese poison in 
the milk, freezing does not destroy micro-organisms 
of any kind, in fact, all organic matter is preserved 
by the freezing process, and when received into the 
alimentary canal is as virulent as before; but a tem- 
perature of 212° is destructive to it, so that in boiling 
the milk we purify it as well as render it more diges- 
tible. There are in the shops sterilizing apparatus, 
which are convenient, but for all practical purposes 
the smallest size Mason fruit jar will answer every 
purpose. The milk may be placed within the jar, 
and the same, without its cover, set in a vessel of 
cold water, which being put upon the stove and 
brought to the boiling point, will have reached that 
degree of heat which is sufficient. After standing a 
moment or two upon being removed from the stove, 
the top of the jar may be screwed on, and then it is 
practically hermetically sealed. The advantage of 
the small jars is that they will hold a quantity suffi- 
cient for use each time, while if the larger ones be 
used, the milk has to be disturbed and runs the risk 
of pollution. 

There may occur cases where even sterilized milk 
will not be digested, and then it may become neces- 



— 23 — 

sary to modify the milk by the addition of barley 
water or some farinaceous article. Some form of 
malt is an admirable addition in these cases. I have 
found no better agent for the purpose than Mellin's 
Food, a teaspoonful or two to one portion of milk 
for a feeding. By its presence in the milk, it being- 
rich in hydrocarbons and dextrose, we have not only 
an aid to digestion, but additional elements of food, 
so that nutrition is better accomplished. Maltine, 
a very attractive form of malt, is also many times 
well received when added to sterilized milk. 

The digestive powers of the infant often are so 
impaired that it becomes necessary to predigest the 
milk, by adding the following formula: 

1$. Piilv. Pancreatic Extract. gr. v 

Sodii Bicarb.. gr. xv 

Saccli. Lac, gr. xv 

M. Ft, ch.,No. I. 

Mix this powder in a gill of warm water and stir it into the 
amount of milk necessary to fill a nursing bottle, then place the 
bottle in a vessel of water at a temperature a little above 100° F. 

By keeping the milk at a temperature of 100° for 
twenty minutes, it will be sufficiently peptonized to 
be well received by the child. If, as sometimes hap- 
pens, a bitter taste is developed, we may know at 
once that we have heated the milk too much or too 
long. Commerce has fortunately provided for us 
peptonizing materials, which are always available 
and very convenient. Fairchild Bros. & Foster's 



— 24 — 

peptogenic milk powder answers an admirable pur- 
pose, and full instructions are given with it, so that 
he who runs may read and use. Parke, Davis & Co., 
with their pancreatic extract, have also furnished us 
that which we can lean upon as a reed unbroken. I 
often find observers object to peptonizing materials, 
because the attendants of the sick room have not 
sufficient intelligence or understanding to properly 
carry out the instructions given. I think, however, 
that we shall find, if we are patient, and make a prac- 
tical demonstration ourselves to the nurse or the 
mother as the case may be, she will readily learn; 
yet in these matters we must ever bear in mind that 
we should have patience to go into every detail, and 
give as perfect a demonstration in as practical a way 
as possible to those who are to carry out our instruc- 
tions. We should take nothing for granted, and we 
should have positive evidence that those who are to 
execute our orders understand them. 

As previously stated, it frequently becomes neces- 
sary for us in the management of-a case of indiges- 
tion in a child to stop all milk food, and we find 
advantage in so doing; in such cases the administra- 
tion of the animal broths is indicated. The expressed 
juice of a rare and tender steak, warm and gently 
salted, will many times be retained and assimilated 
when other food is rejected. We have all observed 
that not only artificially fed babies, but those which 
have been most carefully and completely nourished by 



— 25 — 

their mothers, will, at times, at the table grasp greed- 
ily for the salt cellar and eat heartily of its contents. 
In this we have given us a cue, and we should be 
prompt in reading the lines which follow after, and 
learn that even in the very young there is often a 
demand for the mineral salts. It is needless to refer 
to the physiological necessity of these salines in the 
animal economy, but I fear that we too often fail 
to appreciate their importance, since many times 
these animal broths to which I have referred, rich as 
they are in salts, meet a necessity. I have found 
clam juice of great value, either given warm or cold. 
If the child be feverish, and the weather warm, it 
may be given almost ice-cold. 

There has been recently been presented to the pro- 
fession an admirable product known as Mosquera's 
Beef Meal, a perfectly pure, predigested meat, con- 
taining all the constituents of lean beef, half of which 
are in soluble form ready for assimilation, the other 
half easily digestible by the gastric and pancreatic 
juices. The entire preparation is composed of nutrient 
matter, containing about 40 per cent, of soluble pep- 
tone and albuminose. It is claimed that it represents 
about six times its weight of lean beef. It is quite 
valuable, and is tolerated with ease by the most deli- 
cate stomach. I have found in a number of instances 
that if given in a more or less thick soup, it will be 
taken by the child with avidity, even if quite young. 
Of course, the quantity should be regulated, accord- 



— 26 — 

ing to the delicacy of the stomach. In children of 
larger growth, it may be mixed with porridge, or 
even given in chocolate, or when made into a paste 
may be given in the form of a sandwich. There are 
often times when a rich, rare steak, scraped and thor- 
oughly macerated, from which every shred of con- 
nective tissue has been removed, and the completely 
softened fibre, warmed and salted, is in good form 
for administration, even to very young infants, .par- 
ticularly in those cases where all forms of milk food 
are not tolerated. We must always bear in mind 
that every baby, like every other individual, is a law 
unto itself, and there can be no stereotyped rule for 
the artificial feeding of infants. Regularity, a proper 
regard for the component parts of the food, which 
should meet the necessities of tissue-building, a due 
respect for the palate of the child, and the administra- 
tion of liberal quantities of liquids, will in the major- 
ity of instances completely nourish even the most 
delicate child. 



TETANUS NEONATORUM. 

Tetanus of the newborn is decidedly a preventable 
disease. Recent investigations of bacteriologists 
have demonstrated almost beyond question that teta- 
nus is a disease of the nervous system, dependent 
upon a specific bacilli. The disease is a motor-neuro- 
sis, which shows itself in tonic contractions, some- 
times of the entire muscular system, and sometimes 
of individual muscles. It sometimes is confined to 
the muscles of the jaw, and is then known as trismus. 
Tetanus general is always accompanied by trismus, 
but the latter is not necessarily accompanied by the 
general motor-neurosis. On post-mortem there have 
not as yet been discovered any special lesions. Con- 
gestion of the brain and spinal cord have been 
observed, and some effusion in the arachnoid sac, but 
these are more likely to be results than causes of the 
disease. The most satisfactory explanation of the 
disease, taking into consideration the fact that it is 
an accompaniment of a septic condition, is the bac- 
teriological idea. Tetanus of the newborn has been 
observed for years, more particularly among the lower 
classes and those whose hygienic surroundings were 
the most unfavorable. Among the colored people 
who are crowded together in large numbers, and 
have little appreciation of the importance of cleanli- 



— 28 — 

ness, and who have children pretty much as rabbits, 
tetanus was formerly a cause of great mortality. 
Physicians who practiced before the war among the 
slave population reported enormous numbers of 
deaths from tetanus among the infant class. Since 
there has been an appreciation on the part of the 
profession of the importance of cleanliness in con- 
nection with all surgical procedures, and this thought 
has been applied to the toilet of the umbilicus, there 
has been a great decrease in the number of cases. 
We should realize that every umbilical cord should 
be removed with instruments properly sterilized, 
and that the dressing should be antiseptic, the parts 
having been bathed with a solution of corrosive sub- 
limate, 1 part to 1000. The best dressing for the 
cord is the salicylated absorbent cotton. No grease 
should be permitted, as germs increase and multiply 
in the presence of oleaginous environment. The 
proper treatment of the disease is anti-spasmodic, 
whether it affect the newborn child and be dependent 
upon or independent of irritation about the navel, or 
whether it follow a traumatism. In every case of 
tetanus following an injury we should investigate 
thoroughly our wound, and if possible should open 
up and cleanse the same completely. If it be a mem- 
ber, we should favor amputation. The administration 
of bromide and chloral in ten grain doses of the for- 
mer and two grains of the latter, often enough to 
produce the complete physiological effect, is indicated. 



— 29 — 

Fowler's Solution, pushed to its full toxic effect, has 
been commended. The late Dr. John T. Hodgen, 
for many years a leading surgeon of St. Louis, was 
a strong believer in the value of Fowler's solution in 
heroic doses in tetanus. He reported during his life 
several cases successfully treated in this manner. In 
consideration of the fact that children are very prone 
to injury, we should be ever on the alert as to the 
possibilities of tetanus "as a complication following 
these injuries; even the simplest wound should be 
treated in the completed antiseptic manner. I should 
be inclined to advise that the innermost recesses of 
every part should be washed out thoroughly with 
Marchand's peroxide of hydrogen first, and sub- 
sequently, after being cleansed with pure water, 
thoroughly submerged in a bichloride solution 1 part 
to 2000 of water, and then as completely closed as 
possible — hermetically sealed. 

Fortunately the commercial end of the medical 
profession has furnished us with antiseptic gauzes, 
absorbent cotton and various dressings that can be 
gotten in any well-stocked drug store. Wherever 
possible in the closing of wounds with sutures we 
should use the antiseptic cat-gut suture, for in this 
case the suture is absorbed, and we do not have to 
disturb our wound to remove the same. If the 
wound be deep and cannot be completely closed from 
the bottom, a drainage tube, properly washed out 
from time to time with an antiseptic solution, should 



— 30 — 

be used, and at as early a date as possible we should 
remove the same and apply pressure, with a view to 
closing the cavity. 

These few points regarding the dressing of wounds 
are given simply as prophylactic measures against 
the possible development of tetanus, following simple 
accidents. 



DENTITION. 

There are writers, and good ones, too, who take 
the position that dentition, being entirely a physio- 
logical process, should not be considered under the 
head of disease. They claim that many children 
have been permitted to suffer needlessly with diseases 
that should have been relieved, which were charged 
up to the teething process. Unquestionably to a 
degree they are right. For instance, the thought 
that children during the period of dentition should 
be permitted to have intestinal irritation, and many 
other diseases, and the same be ignored, on the ground 
that it was necessary to the teething process, has 
been responsible for the death of many children. 
But the fact that the profession and the public went 
too far in the direction of justifying many diseased 
conditions on the ground of teething, does not justify 
our going to the other extreme, and saying that den- 
tition or the disturbances incident or necessary to 
dentition are a myth. The time was when during 
the teething process, if children had convulsions, 
disturbed digestion, long continued irritation of the 
bowels, sore eyes, sore mouth, sometimes of a very 
serious character, enlargement of the glands, febrile 
symptoms, at times of a very pronounced nature, 
they were all ignored, and simply charged up to 



teething. This was all wrong, and yet we should 
not say, as some have said, that there is nothing 
involved in the teething process; that it is entirely 
physiological, the same as growths, the same as eat- 
ing a particular meal and the digestion of the same. 
There are certain things that it is necessary for us to 
remember in connection with the teething process. 
I am sure We are not safe in ignoring them. It is true 
that dentition, like all other physiological processes, 
may go on uninterruptedly, without any disturbance 
at all; with very little, at least, though in some cases 
its effect upon the constitution at. large is very 
serious, and may even destroy life in children of a 
very nervous organization. We should teach the 
mothers of the children under our care that during 
the teething process the child is more than usually 
susceptible to disturbances of its health, and for this 
reason deviations should be all the more promptly 
checked. The child in teething, we might almost 
say, is going through its first climateric, and 
needs to be guarded carefully. The thought that it 
is a physiological process, and requires no attention, 
in the light of careful observation, is absurd. We 
may as well say that the bearing of children on the 
part of mothers is completely physiological, quite as 
much so as eating dinner and digesting the same, and 
probably in the early days, in the primitive state of 
society, before the enervating effects of civilization 
had a chance to completely overcome the women 



— 33 — 

of the world, it was so; but in this last decade 
of the nineteenth century, and for the many that 
preceded it, we know fall well that the fruit-bear- 
ers of the animal world, particularly the most per- 
fect specimens of it, those of the highest grade of 
society, give evidence that their work is more patho- 
logical in many instances than physiological, and 
requires the aid of science and the art of the skilled 
physician. If under these latter-day conditions par- 
turition has become, we may say, an almost unnatural 
thing, surely this is justification of the thought 
that the teething process, which is under proper 
conditions thoroughly natural and easy, may become 
the reverse. But leaving all theorizing aside, the 
observation of the careful physician who has had 
many years of practice, is strongly in favor of th 
thought that dentition is not without its dangers. 
There are many pathological conditions which are 
intimately associated with teething, if not as a direct 
cause, at least as a superinducing cause. We are 
safe in saying that the teething process puts the 
nervous-system on edge, renders it hypersensitive, so 
to speak, easily upset, readily demoralized, and pre- 
siding, as it does, over the various functions of the 
body; the equilibrium being interrupted, the result- 
ing condition is a standing invitation to disease. 

I will simply recall to the mind of my reader the 
order in which the teeth usually present themselves: 
From the fifth to the seventh month, the two central 



— 34 — 

lower incisors; from the ninth to the eleventh month, 
the four upper incisors, the two central appearing 
first; from the thirteenth to the fifteenth month, the 
two lower lateral incisors and the four first premolars; 
from the sixteenth to the twentieth month, the 
canines, those in the upper jaw generally preceding 
the lower; from the twentieth to the thirtieth month, 
the second premolars. There of course are variations 
from this rule; the teeth may appear earlier than the 
various orders I have, named, the order may be inter- 
rupted, or ttoey may appear very late. I have ob- 
served several cases where no teeth appeared before 
the child was two years old, and these children 
developed later well, werehealthy, strong and hearty. 
While I would allay the anxieties of a parent where 
there was great delay in the development of the 
teeth, I would at the same time encourage their 
development by the administration of the best form 
of nutrient and tooth-making materials, such as 
cereals and phosphate of lime and soda. Unques- 
tionably a long delay in the appearance of the teeth 
is an expression of a rachitic tendency; that is, that 
the child is short on its mineral supply, and we 
should make up the deficiency. There are cases on 
record of a child being born with one or more of its 
teeth already cut. This in the early times was 
considered to be expressive of a strong, heroic, ag- 
gressive disposition, but I think we are justified in 
looking upon it as a pathological condition. While 



— 35 — 

no case of this kind has come under my observation, 
authors have recorded numbers of cases of children 
born with one, two, or three of their teeth already cut. 
They favored their prompt removal. Usually there 
is an absence of enamel, and sometimes the develop- 
ment of the protruding teeth is only superficial, and 
may be readily removed. Various authors suggest 
that there is always as a cause of the too early ap- 
pearance of the teeth some irritation of the periosteum 
of the alveolar process, and that this irritation has 
advanced the development. They urge removal of 
the appearing tooth, as it favors the relief of the 
generally accompanying periostitis of the alveolar 
process. The condition is a rare one, but when it 
presents itself we should look closely to the local 
conditions. 

The thought that there should necessarily be a di- 
arrhoea or a pronounced bowel trouble with teething, 
or that a teething cough, or a rash upon the skin, 
during the teething process, should be ignored, is all 
wrong; in fact we should remember that whatever 
pathological condition presents itself during the 
teething process, should be promptly relieved, with 
this thought well in mind: that during the teething 
time the bowels should be kept in a thoroughly open 
condition, and should present no appearance of irri- 
tation. Beyond that, a too frequent opening of the 
bowels should be relieved. There is no excuse for 
any cough or disturbance of the bronchial tubes 



— 36 — 

being permitted to continue. It is true that among 
the other conditions that are most apt to occur dur- 
ing dentition is an irritation of the bronchial mucous 
membranes, the little patient being more susceptible 
to " taking cold," and inasmuch as the very young 
when they take cold are very liable to bronchitis, 
the teething child is prone to bronchial irritation. 
It should be promptly relieved, because the condi- 
tions are such that if neglected serious trouble may 
readily develop. 

The Skin. — All skin disturbances should be 
promptly relieved. In the early days there were ob- 
jections, and even yet many of the "good old grand- 
mothers in Israel " oppose the interfering with any 
irritations which may appear upon the skin of the 
teething child. The old-time milk crust was looked 
upon as a dispensation of Providence, as a "blessing 
in disguise," and the one who was indiscreet enough 
to interfere with or heal that rash was in disgrace. 
We should be positive in favoring the earliest possi- 
ble relief to all irritations of the skin. We should 
impress the parents of the child primarily that the 
epithelial or cutaneous disturbances are a reflex from 
a disturbed condition of the alimentary canal, and 
evidence impaired digestion. We should direct our 
attention to a removal of the cause and relieve all 
fermentative conditions of the digestive tube and 
aid digestion in so far as possible. Usually by re- 
moving the cause we cure the cutaneous disturbance; 



but there are times when we need to make applications 
directly to the skin. 

It is well to bear in mind in connection with these 
disturbances of the skin, (which may generally, par- 
ticularly in teething children, be classed under the 
head of Eczema), that in so far as possible all wet 
applications should be avoided. There are many 
varieties of eczema referred to by dermatologists, 
such as E. simplex, E. vesiculosum, E. papillosum, 
E. impetiginote, E. squamosum, E. rubrum, E. uni- 
versale, E. partiale, and so on, ad infinitum, accord- 
ing to special peculiarities or special fondness of der- 
matologists to multiply names. The disease, of 
course, as represented by all these different terms 
varies; in fact the varieties of eczema are as numer- 
ous almost as the individuals. The history of the 
case, the general conditions, and the special condition 
dependent upon the special cause, will enable us to 
make our diagnosis readily. In cases of chronic 
eczema which have continued for a long time the skin 
becomes thickened, rough and fissured with papillary 
hypertrophy and cellular infiltration of the deepest 
layers of the coriurn. In many cases the removal of 
watery applications, the interference with frequent 
washing, and the protection of the skin from the at- 
mosphere, with some soothing, emollient ointment, 
will be all sufficient, if we guard the alimentary 
canal against irritation and properly select the diet. 
In the majority of cases it is well to scrupulously 



— 38 — 

avoid all farinaceous foods. We should also lay 
special stress upon the matter of preventing the 
patient from scratching the itching part, for many 
times the itching is of so pronounced a character, and 
the temptation to scratch so great, that here we will 
have our greatest difficulty. As a means of relieving 
the intolerable itching which sometimes accompanies 
eczema, I have found the following, if applied once 
or twice daily, to be all-sufficient: 

1$. Acid carbolic, 3 ii. 

Glycerin, 3 iv. 

M. 

This is a strong solution, but if properly applied it 
is much less irritating than the too-frequent scratch- 
ing. I have in some cases made it stronger, even 
to the extent of doubling the strength. To pro- 
tect the surfaces against scratching, in the case of 
small children it may often become necessary to glove 
the hands and tie them. On some cases it is neces- 
sary to make a mask which will cover all of the ex- 
posed parts, leaving only a space for the mouth, the 
nostrils and the eyes. Often the plain ointment 
(laying special stress upon the "care of its prepara- 
tion "), of the benzoated oxide of zinc is of great 
value. The best all-round application for eczema, 
however, is the unguentum diachylon albi of Hebra, 
which consists of equal parts of linseed oil and 
diachylon plaster, to be applied on soft linen rags, 
and changed every twelve hour?. There are times, 



— 39 — 

particularly in the flexures of the skin, when a dry- 
ing powder, such as the impure carbonate of zinc, 
is of service. 

I have referred more particularly to eczema for the 
reason that it is the disturbance of the skin most fre- 
quently met with in young children. 
• Let us not forget that in guarding the skin of chil- 
dren as well as adults, we should keep in proper con- 
dition the alimentary canal primarily, and urge upon 
those under our care the importance of the hygiene 
of the skin, bathing at least once a day with tepid 
water and a proper kind of soap. Dr. Merrill Rick- 
etts, of Cincinnati, at a recent meeting of the Mis- 
sissippi Valley Medical Association, presented h 
paper upon skin diseases resulting from the abuse of 
soaps wherein he made very strong points. Undoubt- 
edly there is not proper discretion exercised on the 
part of the household in the selection of soaps for 
domestic use. White castile soap is good all-around 
soap, but one of the best soaps for use in the nursery 
is Pears' soap, and in spite of the fact that somebody 
may benefit by this special commendation, I am ready 
to maintain the position and present in justification 
the fact that probably the highest authority in the 
world upon the skin, Sir Erasmus Wilson, has publicly 
taken the same position. We should impress the par- 
ents of the children under our care from the day of 
birth with the thought that cleanliness is godliness, 
not only cleanliness of the skin, but cleanliness of the 



— 40 — 

inner skin, remembering, as remarked elsewhere, that 
the alimentary canal and the external covering of 
the body are each continuous with the other, of simi- 
lar anatomical structure, varying only in the fact 
that the skin has a thicker layer of epithelial cells as 
a protective ; irritation of the one is reflected to the 
other. Keep, then, the alimentary canal free from 
irritation; keep also the skin in good shape, if you 
would have both healthful, but, mind you, cleansing 
the skin does not mean scrubbing it as you would 
scrub a kitchen floor, with soap equal almost to the 
concentrated lye used on the same. 



INFANTILE THERAPEUTICS. 

In considering " Infantile therapeutics,'' first of all 
I would make the point that Ave must bear in mind 
the delicate organization of a child, the fact that in 
consideration of its incomplete development there is 
much more likely to be an idiosyncrasy against cer- 
tain remedies, and for this reason we need to move 
very carefully in our administration of drugs. We 
should give small doses on general principles, and 
repeat them often, rather than large doses at longer 
intervals. The child is specially susceptible to opi- 
ates and quinine. It bears well such drugs as calo- 
mel, the bichloride of mercury, in fact mercury in 
any form; but of course even these should always be 
given carefully. We should resolve early in our 
management of the diseases of children to form a 
partnership, and throw upon our partner the chief 
work, and this partner should be Nature. The com- 
bination of a careful, conservative, alert, observing 
physician with Dame Nature, and the latter the chief 
member of the firm, will most generally be successful 
in the management of the diseases of children. How- 
ever, we must not trust too much to nature. I have 
no patience with the doctor who is called to a child 
ill and who carelessly says to the parent, " I don't 
believe in giving medicine to children ; open its 



— 42 — 

bowels, and it will be all right in the morning." 
The most careful examination should be made in 
every case, for, while it is true that nature is of 
great value in recuperating and rebuilding the child, 
we must bear in mind that we have a sensitive plant 
to deal with, an undeveloped organism, a creature 
which is made up largely of nervous system, more 
than usually sensitive, and easily agitated, altogether 
presenting great susceptibility to irritation, distur- 
bance, and attack by the various germs and deleteri- 
ous influences which surround it. 

Another point. The child has great elasticity, and 
will not yield to disease until forced to do so, and for 
this reason many times the true condition is masked; 
an ambition to play, an indisposition to yield, will 
many times deceive us. We should be scrupulously, 
religiously careful to investigate every organ, every 
point, connected with the child to which we are 
called; interrogate the parents as to possible expo- 
sure to various diseases incident to childhood; de- 
velop completely all the knowledge that we can with 
regard to heredity, at the same time scanning care- 
fully all the evidence given. We are always safe in 
clearing out the alimentary canal of the child. 
The chances are that there is some error in the major- 
ity of cases; that there is some offending article of 
food in the alimentary canal. The opening up of the 
secretions is important. 

In the olden days, nearly every one, when a phy- 



— 43 — 

sician was called, was promptly vomited. The eme- 
tic has almost become a lost art, and I question 
whether it is sufficiently appreciated. There are 
many conditions which call not only for a complete 
clearing out of the alimentary canal from above 
downwards, but also the beneficial effects of a com- 
plete emptying of the stomach from below upwards. 
The relaxation produced by emesis is of value. It 
has a pronounced derivative effect. It is anti- 
phlogistic. As a prompt emetic in children, the old- 
fashioned ipecac stands pre-eminent. There are 
many conditions, however, which tend in the direc- 
tion of inflammatory troubles, such as pneumonia 
and bronchitis, where in my judgment tartar emetic 
in very small doses — the y^-g- of a grain — every fif- 
teen or twenty minutes, until emesis occurs, is of 
great value. It should not be continued long. 

I have referred elsewhere to the value of water as 
a remedial agent, more particularly externally, in the 
form of the bath. In high-grade fevers the cooling 
bath is the best agent we have for the prompt reduc- 
tion of temperature. It is also a cleanser, and an 
opener of the cutaneous secretions. In chill or inter- 
nal congestion, when accompanied by high fever, the 
hot bath is of great value. In restless, irritable con- 
ditions of the nervous system it is an admirable seda- 
tive. I do not believe, however, that water as an in- 
ternal remedy is sufficiently appreciated. Children 
should be taught to drink freely of water in health. 



_44 — 

It is an aid to digestion, if taken between meals, 
cleansing as it does the stomach and aiding in the di- 
rection of an activity of secretion of the intestinal 
glands. It also encourages the renal work and 
washes out many of the excretory products which 
otherwise might not be removed. There can be no 
doubt that the water-drinker, whether child or adult, 
has a more active tissue change; the food which is 
taken into the alimentary canal finds more active 
secretion, and is therefore sooner put into condition 
to be absorbed, and in addition finds more active 
absorbents and is more promptly taken into the cir- 
culation. In water drinkers there is unquestionably 
a more energetic endosmosis and exosmosis, in fact, 
water, in health and disease, is an energizer to all 
physiological functions. All remedies, whether ad- 
ministered to children or adults, but more particu- 
larly to the former, should be given if possible in the 
fluid form. For the reasons given above, they are 
more promptly taken into the circulation, and the 
greater amount of water they possess, the more 
promptly they are given out of the circulation. 
Probably the chief advantage possessed by the won- 
derful Hot Springs of Arkansas rests less in the 
chemical constituents of the waters of the springs 
than in the fact that the individuals who go there be- 
come great consumers of water, their chief occupation 
being the drinking of large quantities of water, and 
hot water at that, and as we all know, hot water is 



— 45 — 

promptly taken up and given out of the system. 
They who go to Hot Springs as a rule have not been 
water-drinkers. The chances are that many of them 
have been excessive partakers of alcohol, and all the 
tissues of the body are more or less saturated with 
the same, or else they are the victims of venereal dis- 
eases, or possibly rheumatism. In any case, the 
chances are that they are completely saturated with 
medicine and disease. On going to Hot Springs, par- 
taking as they do of such volumes of hot water, 
there is a complete cleansing of the system, a carry- 
ing out by the hot water (which is rapidly thrown 
through them, as through a sewer), of the accumu- 
lated alcohol, venereal poison, rheumatic germs (if 
such things there be), and various forms of medicine 
which have been administered and accumulating for 
months past. The drinking of the hot water, coupled 
with the frequent baths, produces a flow inwardly and 
outwardly, from every direction, flushing and sluicing 
all the tissues and organs of the body. Possibly the 
same process of drinking pure hot water in the same 
large quantities, coupled with similar bathing, at 
home, would possess similar virtues. The only ad- 
vantage of going to Hot Springs is the fact that the 
individual secures a rest from business, pays proper 
attention to the diet, and these are of vital import- 
ance. This diversion was only intended to emphasize 
the value of water as a therapeutic agent. 

Elegance in Medication. — We are neglectful of 



— 46 — 

the interests of our patient, of our profession, of 
humanity, and of ourselves, if we do not pay special 
regard to the palate of our patient in the administra- 
tion of medicine. We have no right to ignore the 
sensitive feelings of our patients in any direction. 
Neglect of the aesthetic side of medicine on the part 
of the early fathers, too great a disposition to feel 
that physical delinquents should be treated by 
heroic measures, should be scourged and have poured 
into them hot-shot, early and often, were largely re- 
sponsible for the development of one of the most 
prominent, irregular branches of the profession. 
Orthodoxy in the early days, unfortunately, both in 
medicine and theology, meant an active, living hell, 
as a punishment of disease, physical and moral. I 
do not believe that we can safely elimininate Hades 
from the treatment of moral evils any more than we 
can completely from the treatment of physical ills. 
However, as the curtain rises higher and higher on 
the panorama which presents itself to us, we are fur- 
nished more and more a scheme of managing chil- 
dren, physically and morally, in a pleasant, cheerful, 
kindly way. 

A Sunday school superintendent called upon a vis- 
iting brother to address his school; the gentleman 
arose and opened his remarks by saying, " Children, 
love one another, confound you." History does not 
relate the subsequent proceedings, but if the children 
had risen en masse and thrown the visitor out of the 



— 47 — 

window, he would have been treated correctly. We 
have presented to us now, by nearly all of the most 
advanced theologians, the thought that the good 
Father thinks of us always affectionately, kindly, 
tenderly, and not specially with a desire to crush and 
condemn us. We are not now told that He created 
us for the specific purpose of damning us. AJ1 of 
the preceding leads to the thought that we are neg- 
lectful of our duty in the management of physical 
ills if we do not study them with a view of relieving 
them in the kindliest, gentlest, most humane way. 
The surgeon who would present himself to a child, 
or even an adult, whose limb was crushed, or whose 
tissues were throbbing with pain, dependent upon a 
local inflammation, and rudely and harshly proceed 
to relieve it without a single tender word, a single 
soothing touch, or the application of some obtunder 
to the shrieking, sensitive nerves, would be a brute. 
The kind, the humane, the thoughtful surgeon knows 
that in the nervous system is where his patient lives, 
and that if he would have prompt healing, a ready 
response after his work is done on the part of his 
patient, he must husband all the nerve force of his 
patient, and for this reason he should save him every 
single pain possible. In as great a degree it is the 
duty of the physician called to the bedside of a 
patient suffering with disease which can only be re- 
lieved by medicine and general treatment, to bear in 
mind also the nervous system of his patient. He 



— 4S — 

should be easy in his approaches, gentle and tendei 
in his movements, kindly of word, thoughtful and 
considerate in the expression of his opinions; with a 
view to what? To save the delicate feeling of his 
patient, not to depress him, even though a child. If 
he enters and finds scarlet fever or diphtheria, and 
rudely and abruptly says: "This child has scarlet 
fever," "This child has diphtheria," he may produce 
a shock injurious to the child, which has possibly 
(from a knowledge of the experience of some play- 
mate), a great dread of the particular disease men. 
tioned. The result produced by the blunderer called 
to relieve him may be a lasting one.* So, then, as the 
physician should be thoughtful of his every word 
spoken in the presence of a child, after having thor- 
oughly interrogated every organ, developed every 
point possible, in his efforts to relieve the conditions, 
he should have sensitive regard for the every comfort 
of the patient. If he administers a remedy which is 
disgusting and revolting and demoralizing to the 
child's stomach, wdiich raises a riot in its administra- 
tion, the question is whether he has done good or 
evil; and the ignoring of these things on the part of 
members of our profession has been largely responsi- 
ble, as before remarked, for the development and the 
growth of one of the special branches of the medical 
profession, whose chief merit lay in the direction of 
an appreciation of the importance of pleasantness 
and elegance in medication (even though the medica- 



— 49 — 

tion was almost nil), coupled with a special regard 
for sanitary points, hygienic surroundings, and a con- 
fidence in the vis meclicatrix natures. It is not 
necessary to go to the extreme of administering in- 
finitesimal nothings in order to give pleasant medi- 
cine. If it be our desire to open up the bowels of 
our patient, we might at first thought feel that a good 
old-fashioned dose of castor oil was the thing, and in 
the majority of instances, if it could be taken pleas- 
antly and easily, it would be a good thing. In this 
connection I will say that castor oil can be given so 
as to be reasonably pleasant, by coupling it with 
lemon juice, or a modicum of whiskey and a little 
sugar sprinkled over it, or in the froth of beer, or 
even in hot milk, flavored with a small amount of 
nutmeg. But if the oil raises a riot, if it arouse 
trouble and resentment, let us give something pleas- 
anter. Fortunately the confections of senna are 
nearly all pleasant to children. The compound licor- 
ice powder will many times be taken by children. 
The Cascara Cordial of P., D. & Co. is agreeable, and 
is a good opener of the bowels, besides it possesses 
the virtue of not only opening the bowels, but serv- 
ing as a tonic to the muscular coat of the same, and 
if continued it will eventually relieve constipation, 
both in infants and adults. However, in the major- 
ity of cases of children whose bowels require open- 
ing we find a perverted secretion and coated tongue, 
and then the little tablet triturates that are manufac- 



— 50 — 

tured now (composed of the tenth or the twentieth 
of a grain of calomel, one-half grain of bicarbon- 
ate of soda and the grain of sugar of milk), are 
readily soluble, and are tasteless, and nearly all chil- 
dren eat them with avidity. 

In the administration of quinine we have had many 
difficulties to contend with in the past. However, 
latterly I feel that the problem of administering qui- 
nine to children has been solved. We find in the 
drug stores the small chocolate tablets containing one 
grain of quinine mingled with a modicum of tannin 
and chocolate, in such form that the quinine is com- 
pletely covered in its taste, and all the children under 
my observation for several years, readily eat the same 
as they would bonbons. I believe, however, that 
some menstruum that holds it in suspension in a form 
to disguise the taste, and at the same time render it 
readily soluble in the stomach, is the most desirable 
way to administer it. Pills and powders are not 
always as well received, at least not always as read- 
ily digested and assimilated by the stomach, as we 
could wish. I have time and again found capsules, 
particularly the gelatin-coated ones, pass through 
the bowel exactly as they entered it; in fact I would 
say that quinine should be administered the same as 
all other medicines, as nearly as possible in a fluid 
form. The following is a good formula, viz.: 



51 — 



3 


Quin. Sulph., 


gr. xxxii. 




Pulr. Tannici, 


gr. x. 




Syr. Rhei. Aromat., 


lii. 




Syr. Tolu, 


?ii. 



Sig. : One or two teaspoonfuls, every two to four hours. 

The following is also an excellent way of adminis- 
tering quinine : viz. — 

R Quin. Sulph., 3 ss. 

Cascara Cordial (P., D. & Co.) | jss. 

Syr. Tolu. fss. 

M. Sig. : Teaspoonful every two hours or as may be desired. 

An advantage of this combination is that the cas- 
cara has a mildly laxative effect in addition to being 
a pleasant vehicle for the quinine. 

When I administer quinine by the stomach, 
whether to children or adults, I always order the fol- 
lowing : viz. — 

^ Pepsin Cordial (P., D. & Co.) I iv. 

Sig. : Teaspoonful with food. 

Quinine disturbs digestion and the pepsine cordial 
given with food, makes up the deficiency of digest- 
ive power. There are times, however, when the 
stomach will not receive quinine to good advantage 
at all. In young infants I rarely have occasion to 
administer it internally, but have great satisfaction 
in applying it in the following : 

3 Quiniae Sulph., fj. 

Sachet Pulvis, q. s. 

M. Ft. Chart Xo. I. 



— 52 — 

Take two layers of flannel six inches square and 
sprinkle the powder uniformly between the same. 
Bind the edges, and having evenly spread the 
quinine between the two layers of flannel, quilt the 
same backwards and forwards and crossways until 
the powder is uniformly held between the meshes of 
the same. Then cover one side of the pad with oil 
silk, moisten the flannel surface with hot whiskey, 
and apply the same directly over the pit of the 
stomach, holdiug it in position with a flannel band- 
age snugly pinned with safety pins. Just in propor ; 
tion as we desire a more complete absorption we will 
renew the application of whiskey to the flannel sur- 
face of the pad, using just enough to moisten the 
same, and not enough to make it soggy and wet. 
Occasionally it may be desirable to use hot vinegar 
in moistening the pad. There is considerable absorp- 
tion of quinine through the skin. Of course, where 
we desire a more pronounced effect we can make a 
larger pad and have it extend over the entire stomach 
and bowels, warning the attendant, however, not to 
make it too large, as it will not fit closely to the 
abdominal wall. I have even in adults produced 
ringing of the ears and other characteristic effects of 
quinine simply by this means. It is much to be pre- 
ferred to the administration of quinine by means of 
ointments. However, there are times when ointments 
may be brought into requisition. Again recalling the 
fact that the skin is only a modified mucous mem- 



— 53 — 

brane, with just a little thicker layer of epithelial 
cells, we can readily understand that absorption is 
sure. We have only to test the absorptive powers of 
the skin by the application of belladonna to a suffi- 
ciently large surface ; we will readily secure pro- 
nounced dilatation of the pupils, and we have all 
seen ptyalism produced by a too liberal supply of 
mercurial ointment to the skin. If we give a suffi- 
cient amount of thought to each prescription that 
we write, and to each case, we can in nearly all in- 
stances give our remedy in a pleasant form. I feel 
that I would be leaving out a very important for- 
mula if I did not present that which I have found 
of great value as an all-round domestic cough mix- 
ture for many years. I think the majority of fami- 
lies under my care in the City of St. Louis keep the 
following formula on hand, particularly during the 
winter months : 

Best Whiskey, 6 ozs. 

Maltine, 1 pt. 

Best Glycerin, 6 ozs. 

Juice of 6 lemons, 
Six tablespoonf uls of sugar, 

Mix and boil fifteen minutes. Dose, a teaspoonful to a table- 
spoonful, according to age, every one, two or three hours, as may 
be indicated. 

This combination is a good expectorant, and is 
valuable in the majority of colds accompanied by 
cough in children, and for that matter in adults as 
well. The' majority of cough mixtures secured by 



— 54 — 

our patients in the shops unfortunately contain ipecac 
and opium, and these disturb digestion and pervert 
secretion. The advantage of the mixture given is 
that there is nothing in it which will impair diges- 
tion, if given within proper limits, and nearly all of 
the component parts are in themselves nutritious, 
and by their presence stimulate and favor nutrition. 



DIETETIC POINTS. 

Just in so far as the family physician impresses 
upon the parent of the child the importance of care- 
fully guarding the general health through the medium 
of its diet, in keeping it in the best possible condi- 
tion, just in so far is he in advance managing his 
cases well from the dietetic stand-point. The ali- 
mentary canal of the child from birth should receive 
the most thoughtful attention of the mother. That 
which goes into it should be most carefully selected 
and prepared, and that which goes from it should be 
closely observed from time to time, and at frequent 
intervals the child should be "weighed in the bal- 
ance " and if " found wanting " more scrupulous care 
should be given than before, with a view of making 
up the deficiency. The mother should know that in 
the case of the child, it not only eats to live but should 
eat to grow. The best and most nutritious food 
should be selected and it should be given at regular 
and proper intervals, and the child should be taught 
to eat carefully and slowly; but, from the beginning 
of the teething process, the family dentist should be 
visited at regular intervals that he may care for the 
teeth, which are of greater importance to the well- 
being of the child than is appreciated by the laity. 
The child should be taught how to masticate for it 



— 56 — 

needs to be taught. We help them in learning to 
walk; we aid them in learning to talk, and we cer- 
tainly should assist them in learning to properly pre- 
pare and^grind their food. Lessons in mastication 
should be a part^of the training of the infant. 
Mothers should study not only how to please 
the palate, but to familiarize themselves with the pri- 
mary principles of physiology to the extent that 
proper selection of food be made in order to accom- 
plish the completest nutrition. Variety is the spice 
of diet. Not only does the palate demand variety, 
but the^tissues as well. Let us not forget to remind 
the mothers'that'the five digestive fluids, are from the 
beginning, dependent upon the proper secretion and 
activityofjthe digestive glands which are a part of 
the glandular^system, and that the entire system must 
be doing proper work or else the individual glandular 
organs^will become crippled. Reasonable muscular 
exercise should be insisted upon, and if the child be 
too } T oung or too delicate to exercise himself, he 
should be given the benefit of massage with lots of 
fresh air from^the very earliest weeks of infantile life. 
There isjar less danger of taking cold in the winter 
time, than there is of being poisoned from breathing 
bad air in close, ill-ventilated rooms. With the sur- 
face properlyjprotected, there is no danger from cold 
air. In many homes there is more sewer gas than 
oxygen, and much of the loss of appetite and im- 
paired nutrition in the child world is due to a neglect 



— 57 — 

of general and personal hygiene. The child that is 
properly clothed can, from the very first month of 
its existence almost, live outdoors the greater part of 
the day-time, winter and summer. There can be no 
demand for fuel in any furnace unless there be drafts; 
there can be no consumption of fuel unless there be 
plenty of oxygen. Much impairment of physique 
and perverted nutrition is due to the neglect of these 
directions. It goes without saying that the well- 
nourished, well cared for tree or plant can withstand 
the ravages of the elements better than the stunted 
one. The uttering or repetition of truisms empha- 
sizes them, and for this reason I feel willing to present 
that which "goes without saying." The well-fed 
child, the child that has a clamorous appetite, whose 
diet is well selected, whose digestion is well per- 
formed, who takes plenty of physical exercise, who 
lives outdoors, and is well clothed, breathes plenty 
of oxygen, rarely takes disease and when he does, 
unless there has been dire neglect of the preliminary 
announcements of the disease, the case can probably 
be successfully managed, at least in the majority of 
cases. Of course the consideration of all these hy- 
gienic points of early life, does good only in the di- 
rection of equipping the child in a manner to resist 
disease; but when we are brought face to face with 
a case of bona fide well-developed illness, happy are 
we if the child has had proper management from 
birth; if it has not, we have all the more reason for 



— 58 — 

availing ourselves of the opportunity for good which 
lies in the direction of nourishing the afflicted one in 
a manner to give it the power of wrestling with its 
enemy. I claim that we are neglectful of our duty 
if we do not preach, yea, if we do not almost fanat- 
ically announce in season and out of season, to the 
parent of the child who is under our care, the im- 
portance of oxygen and exercise and fresh air and 
diet easy of assimilation and of excretion as well. 
As previously remarked, we should teach the mothers 
to know not only what goes into the child, but also 
to carefully observe what comes out of it, and to train 
them in the direction of recognizing variations from 
the normal of the various excretions of the body. 
The child not only runs the risk of poisoning from 
the sewers within our homes, but there is danger of 
sewerage poisoning from its own sewerage system, 
particularly if it be permitted to become clogged and 
engorged. Food means force; the manifestations of 
life are due to the reaction of food with the deriva- 
tives from it and the oxygen upon each other. Dis- 
ease which attacks the blood should, most unquestion- 
ably, be constantly antagonized by that which sustains 
and supports the blood. In our selection of diet, we 
should bear in mind the importance of meeting the 
demand in the direction of furnishing the three 
varieties of food; at least the foods which present 
the elements that go to make up the body and supply 
the blood. The mineral, the vegetable and the ani- 



— 59 — 

mal kingdom should never be lost sight of, and in 
speaking of food, we necessarily include drink. In 
this connection, within reasonable bounds, the more 
liquid there can be given the individual with the 
food, the more ready its assimilation. The nitroge- 
nous articles of food, such as albumen, caseine, etc., 
should be supplied in abundance, and the hydrocar- 
bons, such as sugars and fats should be drawn upon 
liberally and the inorganic as represented by the 
various salts should not be ignored. The food par 
excellence and which should be insisted upon and 
given almost constantly during the progress of 
exhaustive disease, is Nature's ideal nutrition, milk. 
Milk is surely a typical illustration of natural food. 
In its caseine we have the nitrogenous matter; in the 
butter the fatty matter; and in the sugar of milk, 
the additional hydrocarbons, together with the proper 
salines and water, all forming a combination upon 
which one can live indefinitely. In the egg, we 
have an admirable natural food, except that unless it 
be eaten in its entirety, shell and all, it is lacking in 
the salts. But in the egg and milk together, we have 
all the necessary elements of nourishment. Surely 
in milk we have the staff of life, " a nectar for the 
gods." A better nerve builder never was devised. 
Of course, it should be sterilized; it is safer, and be- 
sides after being boiled, it is more digestible. Given 
in peptonized form, it is readily assimilated and if 
this be done carefully, the taste is not affected. I 



— 60 — 

would suggest that many times where the milk has 
been peptonized and the bitter taste developed, we 
may be sure that the milk has been heated too much. 
In the majority of instances, a slight heating of the 
same is 'all that is necessary, and often we need 
not warm it at all, but stir the peptogenic powder 
into the milk and the digestion goes on after it 
reaches the stomach. The point may be made 
many times, that the child will not take the milk; 
that it either does not like it on general principles or 
that it has formed an aversion to it. Diplomacy will 
generally overcome this. If the child be not under 
(as unfortunately is often the case) the complete con- 
trol of the parent; if it be a spoiled, petted, capri- 
cious darling, we will have many difficulties. The 
little fellow may be hired by one means or another 
to take his milk and other articles of diet as a matter 
of duty and for the reward which he will receive; 
and we should carefully study the individuality of 
each little one, win his confidence and love and get 
him to do as we wish for our sake and the sake of 
those who love him. Beef fibre in the form of rare 
steak properly prepared, is acceptable to the palate 
and is the most nutritious of all the animal foods, 
although well ripened mutton is a shade more diges- 
tible. The young green fleshes, such as veal and 
lamb should be tabooed. The soft part of raw 
oysters is nourishing; with a little lemon juice over 
them and salted well, they would many times be 



— 61 — 

eaten by the child who has not yet cultivated the 
taste for oysters; and they possess the advantage of 
almost digesting themselves. Clam juice and beef 
juice, domestic and commercial, in the form of 
bouillon or bovinine are admirable. The domestic 
beef tea has been supposed to be of no value as a 
nourishment. Of course, it is lacking in the stronger 
elements of nutrition, but the salts which it contains 
are gently stimulating and besides they are of value 
as pleasers of the palate, so it may be given freely. 
The advantage of beef peptones and bovinine is that 
they contain large quantities of albuminous matter 
and well digested excellent beef fibre. They may be 
given in teaspoonful doses every two or three hours, 
exactly as you would give medicine. If a few drops 
of brandy be added to it or good Tokay wine, 
the combination is even better. Sweet-breads, if 
stewed and delicately cooked, without the addition 
of the stimulating condiments which usually accom- 
pany them, are very nutritious and digestible and 
will many times be found very acceptable. In the 
selection of sweet-breads, we should confine ourselves 
to the use of the pancreas and exclude the thymus 
gland. Venison, when in season, and the various 
game, such as quail, prairie chicken, wood duck, etc., 
if selection be made from the breast of the birds and 
the loin of the venison, are most palatable, and if 
properly cooked, are digestible and nutritious. 
Vegetables are of great value as they contain a great 



— 62 — 

deal of starch and saccharine matter. Simply from 
the stand-point of variety they are of advantage. 
The cereals, such as wheat flour, oat-meal and corn- 
meal may all be utilized and be of excellent advan- 
tage. Puddings made of corn starch with milk are 
nutritious and in many cases, very pleasant to the 
palate of the child. Rice is one of the most valu- 
able, farinaceous articles of diet, and if properly 
cooked, it is very digestible and seems especially 
acceptable to the alimentary canal, often when the 
same is irritated. Potato is a very nutritious form 
of starchy food, and should be thoroughly ripe and 
well cooked. The best way of cooking them is either 
steaming them or baking with the peeling on. The 
cauliflower is delicate, and when well cooked is rea- 
sonably digestible. Belonging as it does to the cab- 
bage tribe, however, it should only be eaten in small 
quantities. The tomato is a very agreeable acid 
food but is more valuable as a relish than for its 
nutritive properties. It is a good addition to soups 
as it adds attractiveness and pleases the palate. It 
is an excellent antiscorbutic. Well selected and 
properly cooked asparagus, the tender portion of it 
in particular, is delicate and enjoyable and is a most 
excellent stimulant to the urinary apparatus. Spin- 
ach, thoroughly cooked is not only enjoyable but it 
serves an admirable purpose in the direction of relax- 
ing the bowels, and of course, should be carefully 
given for this reason. It has been declared by author- 



— 63 — 

ities on dietetics, to be wholesome and if given cau- 
tiously, it aids digestion in that it stimulates secretion 
by its presence in the alimentary canal. I have fre- 
quently found the stalks of rhubarb or pie plant when 
well stewed, to be very acceptable to children, partic- 
ularly those craving acids, and if given in reasonable 
quantities, of value to the appetite. 

Fruit is of great value not only in health but in 
sickness, and properly prepared fruit will be of ser- 
vice, but it must not be over ripe or green. It is 
an agreeable and refreshing kind of food, and eaten 
in moderate quantities exercises a favorable influence 
as an article of diet. It is chiefly of service, looking' 
at the actual material afforded, for the carbohydrates, 
vegetable acids and salts it contains. It is decidedly 
antiscorbutic. When we are in doubt about the 
digestive powers, it is well for the fruit to be cooked. 
The effect of fruit is to diminish the acidity of the 
urine. The alkaline vegetable salts which are con- 
tained in fruits, become decomposed in the system, 
change into the carbonate of the alkali and are elimin- 
ated with the urine ; for that reason it is likely to 
prove favorable in gout and the rheumatic diathesis, 
wherein the urine shows a tendency to throw down a 
deposit of lithic acid. There having been recently 
established, clinically at least, a very close relation- 
ship between the gouty and rheumatic diatheses and 
the inflammatory diseases of the throat, particularly of 
the tonsils, for the reason just given, the fruit diet is 



— 64 — 

specially indicated in all troubles affecting the throat 
and glandular system. The various fruits which are 
particularly valuable as articles of diet, are accessi- 
ble and freely grown in America; among them the 
pomaceous group stands first. Of this group, the 
apple and pear are easily obtained and are fortunately 
of the greatest value. In the raw state, the apple is 
not considered easy of digestion ; but when carefully 
selected and well ripened, there are many times when 
a scraped apple may be given to advantage, with- 
out burdening the digestive powers, and there is 
nothing more grateful to the palate of the child. 
The apple if cooked however, is light and digestible, 
and no better laxative for the bowels can be given 
than roasted apples. The best variety of pears is a 
very delicate fruit. If well ripened before plucking 
and reasonably fresh, a soft luscious pear is more 
digestible than the apple. Unless very ripe and 
very soft, the pear should be cooked. Oranges, par- 
ticularly from the southern part gf America, are abun- 
dant and even the imported oranges are so easily 
grown and cheap, that they are, when in season, very 
available. The orange is exceedingly grateful and 
cheering to the palate, and if thoroughly ripe and 
reasonably fresh, it is very seldom liable to create 
disturbance in the alimentary canal ; and it may be 
admitted under almost all conditions either of health 
or disease. Lemon juice in the form of lemonade is 
an agreeable beverage in all feverish conditions and 



— 05 — 

it is rarely objectionable unless given in excess. As 
a food, I cannot pass over the importance of alcohol 
and the malt en liquors. Whatever the dictum of 
the schools may be with reference to alcohol in rela- 
tion to its food powers, clinically, it is of unquestion- 
able value. In the form of brandy of the best qual- 
ity and good Tokay wine it is nearly always ac- 
ceptable to children, and we have that upon which 
I believe we can safely lean. It should be given 
carefully and with proper discrimination, but aside 
from being of value as a nourishment and as a stimu- 
lator of the flagging energies, it is also to a certain 
extent a local and general antiseptic. Malt is a bev- 
erage which many times will serve us well. It is not 
only nutritious in itself, but it aids by its presence in 
the stomach in the digestion of farinaceous foods. 
A special malt known as " Maltine " is very attractive 
to children. Ice cream, if properly made, or frozen 
custard is, in small quantities at a time, very pleas- 
ing to the heated and parched mouth and throat and 
is very nutritious. Nearly all children are delighted 
with the promise of such morsels and we may many 
times by this means not only aid in feeding satisfac- 
torily but by giving such things as a reward for taking 
medicine, we the more gracefully accomplish our 
desires, in other matters. 

A new food has been under my observation for 
several months and hardly a day has passed that I 
have not prescribed it liberally. It is known as 

5 



— m — 

Mosquera's Beet' Cacao, and as nearly all children are 
fond of chocolate, they will readily partake of it, 
Mosquera's Beef Cacao consists of equal parts of beef 
meal, sugar, and a superior article of Dutch Cacao. 
It does not require cooking but may be mixed with 
warm milk exactly like ordinary chocolate and so 
completely is the taste of the beef disguised that it 
cannot be detected. Requiring therefore no previous 
preparation, it ,is most conveniently administered. 
Another excellent condensed food in the shops, of 
great value, under the name of Mosquera's Beef Meal, 
contains all the inorganic salts and stimulating prin- 
ciples of the extracts of meat and in addition the 
nutritive principles which the extracts lack ; all the 
albumen of meat juices without their weakness ; all 
the extracts of powdered meats without their ran- 
cidity or insolubility; all the peptone of the pepton- 
ized meats without their bitterness. " Mosquera's Beef 
Meal is a perfectly pure predigested meat, containing 
all the nutritious constituents of lean beef, half of 
which are in a soluble form ready for assimilation ; 
the other half easily digestible by the gastric and 
pancreatic juices. The entire preparation is com- 
posed of nutritive matter, containing about 40 per 
cent, of soluble peptone and albuminose. Mosquera's 
Beef Meal represents in actual nutritive value at 
least six times its weight of lean beef. " It is per- 
fectly palatable and will be tolerated with ease by 
the most delicate stomach. It admits of being 



— 67 — 

administered in a variety of forms, thus avoiding 
monotony in the food. It may be given in any thick 
soup, condimented to suit the taste of the patient, or 
also mixed with biscuit powder, oatmeal, porridge 
and milk and sugar. Again it may be mixed with 
chocolate, which makes a delicious beverage, or 
given in the form of a sandwich, and, finally, as a 
plain beef tea, simply dissolving it in hot water, add- 
ing salt. 

To sum up : — Food which is rich in the elements 
of nutrition should be constantly presented to the 
children suffering with disease. In order not to sur- 
feit the stomach, it should be given carefully and at 
proper intervals and in proper variety. The matter 
of nutrition should never be lost sight of in the prep- 
aration of the food, but due regard for the palate 
and the digestive powers should always be had. In 
the presenting of food, the attendants of the sick 
room should be impressed with the importance of not 
only having it properly prepared, but of presenting 
it in an attractive way. The little ones have their 
esthetic tastes the same as we have ; and the china 
should be well selected and all the utensils in which 
delicate morsels are placed before the sufferer, should 
be scrupulously neat and clean. Care should be 
taken in the linen; the little attractive waiters upon 
which the food rests should be well kept and everv- 
thing pleasantly arranged for the sensitive feelings 
of the invalid. A bunch of flowers placed in proper 



— 68 — 

position upon the little sick one's table will often do 
much to brighten an otherwise unattractive spread. 
We cannot be too careful in all the various details 
that go to make up the necessities of the sick room. 
As physicians, we can often help out the digestion of 
the little one under our care by thoughtfully study- 
ing the artistic side of alimentation and giving 
pointers to those who are helping us in our work. 

The patient, be he ever so young, will suffer and 
the result of our treatment is much less likely to be 
favorable to us if we fail to appreciate the impor- 
tance of catering to the " psychical satisfaction " of 
the sufferer. 

The nervous system is a very complex organization 
and anything which rudely disturbs the palate, may 
upset the whole system. That which is disagreeable 
or unattractive to the eye, the nose and the palate, 
may create a general disgust in the nervous ranks, 
and indigestion, non-assimilation, irritation, restless- 
ness, friction and a loss of force ba the result. 

Let us husband every resource we possibly can for 
the good of our patient, and never lose sight of the 
thought that nothing which pertains to and assists in 
the securement of a successful result, is trifling. 



CATARRHAL FEVERS. 

As the term would indicate, catarrh means a flow, 
and it is applied as expressing an inflammatory con- 
dition of the mucous membranes, whether it affect 
the alimentary canal or the air passages. As has 
previously been stated, intestinal catarrh, either pro- 
duced by errors in diet, weakened digestion or the 
chilling of the surface, as commonly expressed in 
"cold," is the most frequent disturbance of early 
childhood, and next in order is a catarrh of the re- 
spiratory mucous membranes. Steiner states that at 
the Prague hospital for sick children, out of an annual 
clientele of 9,000 patients there were on an average 
1,300 children suffering from catarrh of the air pas- 
sages. Of course, we may have either primary or 
secondary, acute or chronic catarrh. The symptoms 
and the suffering of the child vary according to the 
particular part of the respiratory apparatus which 
may be affected. If the congestive and inflammatory 
disturbance be within the nasal passages, we may 
simply have a mild case of snuffles. If it be in the 
upper air passages, — the upper bronchial tubes, we 
may have a mild case of bronchitis. But we must 
always bear in mind that by continuity of surface, 
and from the fact that the secretions of the irritated 
surface cannot be readily expelled from the child, we 



— 70 — 

are ever in danger of the inflammation extending into 
the smaller bronchial tubes, and result in a capillary 
bronchitis. If the mucous membrane is inflamed, we 
will find that it is injected, either generally or in 
patches, swollen, at times almost oedematus, with a 
rich secretion of mucus, which sometimes may be 
almost muco-purulent. If this condition of the 
mucous membrane, or this catarrhal attack, be with- 
in the larynx, we may have a case of acute laryngitis 
or croup to contend with. The initiatory stage 
of the disease is the dry stage, the parts being- 
dry, gorged and painful. The secondary stage is 
that of secretion. Of course, if the bronchial mu- 
cous membranes be involved in the first stage, the 
cough is hard, dry and painful, and sometimes very 
tormenting. When the stage of secretion follows, 
the cough becomes moister. The younger the child 
the graver the danger, and in very young children a 
dry, light cold affecting the air passage may prove 
fatal in a very short time. A simple case of snuffles 
should receive our promptest attention, for it means 
obstruction to the breathing apparatus; it means 
irritative catarrhal fever of a greater or less charac- 
ter. But if there be evidence of bronchial irritation 
or laryngeal distress, whether the child be young or 
more advanced in years, we should bear in mind the 
possibilities, and never ignore it. We should invari- 
ably take the temperature, for we shall sometimes be 
surprised to find how high the temperature will go, 



— 71 — 

when the mother had thought that the child had only 
a cold. 

" Only a Cold " sometimes means a dangerous or 
deadly capillary bronchitis within a few hours, or 
pneumonia. Those of us who have had an acute 
cold or influenza, with all the accompanying aching 
of every muscle, soreness of chest, constant inclina- 
tion to cough, which when responded to racks 
every nerve in the body, accompanied by splitting 
headache, may readily understand that when such an 
attack rattles us so completely, and so nearly 
"knocks us out," it is really dangerous to the young- 
child. We shall be working in the direction of oar 
duty if we impress upon mothers who employ us as 
physicians the fact that their babies, even their chil- 
dren of larger growth, can never have a cold without 
being in danger of something worse, and every cold 
needs prompt treatment; nursing, coddling, kindly 
care. On general principles, the first indication in 
these cases is to produce a complete relaxation, and 
to this end nothing is better than a hot bath, unless 
the temperature already be high, in which case the 
bath should have a mild degree of warmth. A mild 
remedy should then be given to open up and clear 
out the alimentary canal. The good old-fashioned 
dose of oil is well, but many times we shall find great 
objections to the taking of the same, particularly on 
the part of older children, and in addition an aversion 
by the mother to the administration; but whether oil 



— 72 — 

be given or not, the mild chloride and ipecac should 
always be given, in the following formula: 

5 Hydrarg. chlor. mitis, gr. 1. 

Ipecacuanhas pulv., gr. ss. 

Sacchari lact., gr. x. 

Sacchari albi, gr. xx. 

M. Ft. chart No. x. Sig. : One half or one full powder 
every two hours, according to age. 

This little stereotyped formula serves admirably as 
a stimulator of the secretory systems of glands, not 
only of the alimentary canal, but also of the mucous 
glands of the air passages. One of the sheet anchors 
in these cases is the muriate of ammonia, in doses of 
from one to five grains (well diluted with water), 
according to age, every one, two or three hours, as 
may be indicated. It will soften up and loosen a 
harsh, dry irritable condition of the air passages 
more rapidly than any remedy within my knowledge. 
If the catarrhal disturbance be located (and nearly 
always there is some of it at least), within the nasal 
passages, we should direct our -thoughts towards 
soothing and opening up the same, with a view of 
aiding respiration, and to this end the free floating 
through the nostrils of melted vaseline or liquid albo- 
line is good. We may often relieve as by magic the 
discomforts of an almost frantic child by soothing 
the irritated membrane, and secure a more prompt 
resolution of the inflammation. The more promptly 
we can relieve and remove entirely the morbid condi- 
tions of these mucous membranes in the children 



— 73 — 

under our care the better; because, aside from the 
discomforts, aside from the dangers immediately in- 
cident to the inflammatory disturbance, we must re- 
member there is constantly a tendency towards a 
chronic irritation in these parts if they are not 
promptly relieved. The inflammation may be of 
such a character as to denude the mucous membrane 
in spots here and there, and whether denuded or 
simply inflamed, if this condition is permitted to re- 
main we have present in our little patient a constant 
invitation to various germs which are ever present in 
the atmosphere to enter and abide therein. In cities 
more particularly, where diphtheria, scarlet fever and 
various other germ diseases, like the poor, are always 
with us, we should realize that the sooner we get our 
little one in a perfectly healthy condition, particularly 
in its mucous membranes, the less the liability to its 
falling a victim to the disease mentioned. So even 
a simple cold in the head if neglected may breed a 
chronic nasal catarrh, or if continued, whether acute 
or chronic, we must remember this particular child is 
all the more susceptible to the contagion of diph- 
theria and other diseases; and diphtheria which gains 
entrance through the medium of the nasal passages is 
a serious form, for the reason that it is frequently 
overlooked, and thought to be nothing more than a 
suppurating catarrh for days, until the patient falls a 
victim to an overwhelming blood poisoning. When 
we bear in mind the anatomical structure, and the 



— 74 — 

free distribution of lymphatics in the nasal passages, 
we understand why diphtheria gains such rapid en- 
trance into the circulation, and causes such profound 
systemic poisoning, when located in this region. 

The benzoate of soda is an admirable remedy to 
stimulate secretions and expectoration, so that it is 
specially indicated in these troubles affecting the air 
passages; besides it is known to be, as was established 
by Salkowski in 1879, antagonistic to diphtheria. 

Laryngeal Catarrh. — If the catarrhal inflamma- 
tion attack the larynx, we may have almost danger- 
ous symptoms developed rapidly. A harassing 
laryngeal cough in a very young infant may soon be- 
come dangerous. If the spasmodic feature be devel- 
oped as it often is, we have the spasmodic croup, 
which is so greatly dreaded by the mother. It usually 
comes on suddenly, and our summons to these cases 
is nearly always in the night, the entire household is 
demoralized, and the child, particularly if it be young, 
will at times seem almost suffocating. The indica- 
tion here, of course, is prompt emesis, and the sim- 
plest agent at hand is the syrup of ipecac. We will 
usually find that this has already been given. For 
children beyond six months of age, the turpeth min- 
eral, in doses of one-half grain every hour, until free 
vomiting occurs, is in my judgment one of the best 
remedies we have. The emesis produced is an addi- 
tional advantage in that it is antagonistic to inflam- 
mation, as also is the mercurial effect. 



— 75 — 

Croup. — The question of diagnosis between sim- 
ple spasmodic croup or catarrh of the larynx with 
spasmodic complications, and membranous croup 
often presents itself, the difference being that the one 
is mild and usually readily relieved, and the other, of 
course, is deadly dangerous. The throwing out of 
the pseudo-membrane upon the larynx, and upon the 
trachea may soon endanger life by obstruction to 
respiration. We are never safe in telling parents 
positively when a child has been relieved by the 
usual remedies of a case of spasmodic croup that 
there may not be the membranous croup developing. 
Of course there is always more or less fever with 
simple croup, but if the fever be high and continuous, 
even if the spasmodic fits be relieved, there is danger, 
and we should be on the alert. I have found, not 
only for the relief of the simple spasmodic croup, but 
for the inflammatory condition of the larynx and the 
parts adjacent, the administration of infinitesimal 
doses of tartar emetic of great value. Some declare 
antimony to be too powerful a remedy to be adminis- 
tered to infants, the same as there are those who de- 
cry against calomel ; but the old-time administration 
of calomel and antimony differs very materially from 
the manner in which it is given to-day. The practi- 
tioner who gives large doses of calomel to infants or 
parents is misdirecting his energy. Certainly I feel 
justified in believing that large doses of antimony are 
dangerous, but the lancet and the scalpel are both 



— 76 — 

dangerous when handled unskillfully or in excess ; an 
argument against their abuse and excessive use is no 
argument against their proper use. A very conven- 
ient method I have found to be to carry with me 
little pellets or powders of tartar emetic, of about £ 
grain each. I then dissolve one in a half glass of 
water, and instruct them, according to the degree of 
hoarseness and irritability in the larynx, to administer 
a teaspoonful of the solution every ten minutes until 
there is a soothing effect produced in the coughing, 
or until emesis occurs. I very rarely fail to find 
good results follow. One advantage of the adminis- 
tration, or disadvantage, whichever we may consider 
it, is that we are credited with being somewhat 
homeopathic ; but, in any event, the result is satisfac- 
tory. 

The atmosphere of the child suffering with croup 
should be made as moist as possible and this can be 
accomplished by placing a small vessel of water over 
an alcohol lamp in the room. If an ounce of car- 
bolic acid is placed in a pint of hot water and kept 
boiling every now and then for a few minutes, the 
charging of the air with carbolic acid will soothe the 
irritated mucous membrane of the air passages. Oc- 
casionally an ounce each of turpentine and pine tar 
in the water is preferable. 



TONSI LLITIS. 

Tonsillitis is a disease peculiarly incident to chil- 
dren. While fortunately very young babies are not 
liable to it, yet occasionally it does occur, a case 
being recorded of a tonsilar abscess in a child only 
three weeks old. The cases may be ushered in with 
a chill, followed by fever, vomiting, bleeding from 
the nose, sneezing, etc., and in very young children 
there may be high delirium from the start, though in 
some cases there may be an active inflammation of 
the tonsils, without any of these marked symptoms. 
We are never safe in neglecting to examine the 
throat of every child to which we are called. This 
may be accomplished readily, no matter how young 
the child, if we are careful, and I believe the most 
satisfactory method is the use of the finger, the same 
having been carefully and thoroughly cleansed with 
soap and water. It is soft and pliable. We have 
an additional advantage, if we use it deftly, that we 
not only see the throat thoroughly well, with the 
light properly directed, but at the same time, through 
the medium of our third eye, which we should ever 
carry in our index finger, we can determine much as 
to the condition of the mucous membrane of the 
tongue. If the child be old enough to express itself, 
it will soon direct the attention of its mother to the 



— 78 — 

fact that it has a burning and a dryness in the 
throat, and difficulty in swallowing. If one or both 
tonsils be involved, the accompanying symptoms 
vary, of course, being the more severe with the 
double tonsillitis. The glands are usually found 
swollen and spotted with reddened patches, the honey- 
comb structure of the tonsil can be readily observed, 
an accumulation of whitened mucous being in posi- 
tion corresponding to each follicle, and sometimes 
pus is exuding from the follicular openings ; but in 
the more violent cases the tonsils are so swollen, dark 
and red in color as to be almost bursting, and nearly 
touch one another, almost completely closing the 
isthmus of the fauces. Fortunately inflammation of 
the tonsils does not occur often in very young chil- 
dren. 

I consider that jDoulticing the neck in the neigh- 
borhood of the angles of the jaw, with flannel cloths 
rung out of hot water and arnica or witch hazel is 
of service. The fomentations certainly are soothing. 
Remedies which open the bowels promptly are indi- 
cated. 

In 1885 I published a paper wherein I favored the 
administration of the benzoate of soda internally 
freely, as being almost a specific for tonsillitis. The 
paper was read before the St. Louis Medical Society 
at that time, commending the benzoate of soda as a 
remedy in diphtheria, on account of its stimulating 
qualities upon the mucous glands. It has a tendency 



— 79 — 

to soften the secretions and encourage exosmosis or a 
current from the interior to the exterior and this flow 
from within outward soon enables the parts to throw 
off the deposited membrane in diphtheria, The soda 
benzoate being in itself somewhat of a germicide, 
was certainly desirable in diphtheria but on account of 
its action alone referred to, I feel that it was also the 
ideal treatment for simple tonsillitis. This treatment 
was subsequently explained verbally to a staff of 
physicians at the Mullanphy hospital, St. Louis, and 
they later, chiefly through Dr. Boisliniere, treated 
some 600 cases of tonsillitis, and found the benzoate 
of soda the best remedy. If given to children in 5 to 
10 grain doses every one or two hours, as the case 
may demand, it rapidly causes a throwing off of se- 
cretions from a previously dry, engorged, angry and 
painful tonsil. The flow is upward and outward 
through the mucous glands. Pus and various other 
accumulations are thus thrown off, and I am sure that 
the case terminates, if seen early, in one fourth of 
the time usually required, and suppuration rarely 
occurs. The accumulation of mucus and pus upon 
the tonsils in a case of follicular tonsillitis may some- 
times simulate the membrane of diphtheria, and no 
doubt some cases have been declared diphtheria which 
were only follicular tonsillitis; but we should always 
bear in mind that now, particularly in cities, diph- 
theria is an endemic disease, and that every case of 
tonsillitis, or inflammation of the raucous membrane 



— 80 — 

of the air passage, is a standing invitation to diph- 
theria. A case of follicular tonslilitis may if we are 
not upon the alert suddenly emerge from a pain- 
ful but non-dangerous disease into the deadly, 
treacherous, diphtheria. I feel that we are neglect- 
ful of our duty if we do not constantly bear in mind 
this fact in every simple case of sore throat which 
we treat, and let all applications be in the nature of 
germicides ; let our administrations of internal medi- 
cine be supporting and strengthening, and antagon- 
istic to germ diseases ; and to this end the bichloride 
of mercury in -£-$ grain doses, well diluted, given in- 
ternally, together with the benzoate of soda, are in 
the right direction. Locally gargles or applications 
which we may make either by means of the probang, 
or better still, by the atomizer, should always, and 
fortunately may now very readily be made antagon- 
istic to the diphtheria poison, at the same time being 
soothing and sedative to the inflamed surface. 

I should treat no case of tonsillitis without occasion- 
ally spraying the surface (simply for the sake of feel- 
ing safer myself) of the inflamed tonsil occasionally 
with Marchand's^ peroxide of hydrogen. This is a 
rapid oxidizer of organic matter, and is unquestiona- 
bly a germicide. It may be used in its purity or di- 
luted with one-half of water. If the parts be sensi- 
tive, a very excellent application to them is a spray 
of the following : 



— SI — 

B Tr. calendula, 3 j. 

Fid. ext. hamamelis (P., D. & Co.), 3iij. 

Soda biborate, 3 ij. 

Glycerin, 5 ss. 

Aquarosa, 3 iij. 
M. 

This may be used every hour or two, as the case 
may be. If the parts are very painful, I have often 
observed that a gargling or spraying of the surface 
with hot milk to which a teaspoonful of baking soda 
had been added to a glassful is very soothing. If 
the child should swallow this particular gargle, it 
will be an advantage. The cases usually terminate 
favorably inside of 24 or 48 hours under this plan of 
treatment. 



ENLARGED TONSILS. 

The consideration of tonsillitis naturally brings 
up the subject of enlarged tonsils. This hypertro- 
phied condition of the tonsils does not usually follow 
a single attack of tonsillitis, although it may do so, 
but is much more apt to be the result of repeated at- 
tacks. According to my observation, children who 
are the product of strumous parentage, particularly 
of a remote syphilis on the part of the parents, are 
more prone to a chronic enlargement of the tonsils. 
The inflammatory exudation is less liable to be 
absorbed. The seriousness of the condition depends 
very much upon the degree of the enlargement. 
Sometimes, if it be not very extensive, mild astring- 
ents persistently applied will reduce the size of the 
tonsil, and I certainly think that alterative medicines 
should be administered. The syrup of hydriodic acid 
in teaspoonful doses, as a tonic, or the compound 
syrup of hypophosphites, is of value. The building 
up of the general health, the guarding against a re- 
petition of colds, all favor the gradual absorption of 
the inflammatory material. There may be cases, how- 
ever, where the enlargement is very great, they being 
even as large as pigeon eggs, nearly touching and 
blocking up the fauces. Where this is the condition, 
I believe the impairment of health, and obstruction 



— 83 — 

to breathing is so pronounced as to render a removal 
absolutely necessary. The general health is im- 
paired, besides the child assumes a dull, heavy look, 
goes about with its mouth open, breathing through 
its nose, and, as is said to have been observed by the 
savages of old, there is a disposition toward credit- 
ing it with a stupidity which it does not possess. 
The old Indian adage was, " fear not the man who 
keeps his mouth open." Where the tonsil is so much 
hypertrophied as to produce an obstruction to breath- 
ing, or interference with the comfort of the individ- 
ual, it should certainly be removed. A child is much 
more liable to attacks of pharyngeal catarrh, is more 
in danger of diphtheria and the other contagious dis- 
eases; and where there has been so great a growth of 
adventitious tissue, we cannot hope to secure its re- 
duction by other means than removal. It has been 
stated that towards puberty the affection will dis- 
appear of itself. If the child be quite young, the 
operation is not an easy one, and I believe in the 
tentative methods until a child is advanced to the age 
of four, five or six, yet, fortunately, the degree of en- 
largement which requires removal does not occur 
often in the very young. 

In this connection, I think we should not fail to 
impress upon the mothers of the little ones the im- 
portance of early teaching them to gargle their 
throats with cold water or salt and water. It is 
cleansing, and besides the knowledge may be of value 



— 84 — 

to us later if the child have trouble demanding it. 
We should also early familiarize them with the atom- 
izer. In. health train them and prepare them for the 
necessary procedures of disease, as we would in peace 
prepare for war. I think many a child's life has been 
saved by having had this training from a thoughtful 
mother, suggested by a thoughtful physician. 

We are neglectful of our duty if we do not impress 
upon parents the thought that they can never take 
chances in these inflammatory disturbances of the 
throat. They should not trust their diagnostic abili- 
ties. I have repeatedly found supposed cases of sim- 
ple sore throat, which had been under the care of the 
mother, to be well-advanced cases of unsuspected 
diphtheria. I recall an instance in my office, one 
morning in the winter of 1888, when a mother pre- 
sented herself with four of her children, all of whom 
she said had a sore throat, like they had often had 
before, and which she had always -been able to cope 
with, but the trouble now did not seem to yield. I 
examined them, and was horrified to find all of them 
far advanced cases of diphtheria, and one already 
presented the huskiness and hoarseness of a laryn- 
geal complication, and died before night. The 
mother could hardly realize that she had been during 
all these days almost criminally neglectful of the in- 
terests of her children. 



DIPHTH ERIA. 

Diphtheria is a disease which under various names 
has existed for many hundreds of years and being so 
widely diffused and so destructive in its results, it 
must always be of interest to the student of medi- 
cine. The amount that has been written regarding 
it during the past two hundred years would make 
volumes sufficient to fill a library, and yet we are still 
greatly at sea regarding its pathology, and, if the 
testimony of many writers is to be accepted, we know 
less of its proper treatment. The most important 
monograph of the century upon this subject was that 
of Bretonneau (1826) composed of a series of essays 
read before the French Academy of Medicine, the 
first essay presented to the Academy June 26, 1821, 
from which may be dated the modern history of 
diphtheria — the author creating the name diphtheria 
and giving us the best insight into its pathology. 
Not until 1859 did English medical literature adopt 
the name when the Sydenham Society published a 
volume of memoirs of the disease translated from the 
French of Bretonneau and others. 

A novice in the profession, as he reads the works 
of the various authors and the testimony of observers 
regarding general diseases, may at times feel that his 
views are very clear, opinions well fixed and defined, 



— 86 — 

and his plan of action in his work positive and well 
decided; but he will not advance very far without 
being convinced that "theories and the pen are 
mightier than practice," and at no time will this con- 
viction press itself upon him with greater force than 
when wrestling with that most described and little 
known, but ever treacherous disease, diphtheria. 

Most authors agree that the disease is specific, in- 
fectious and contagious, sometimes prevails as an 
epidemic and is endemic in certain places, and that 
it is characterized by the exudation in various situa- 
tions, particularly on mucous membranes and the sur- 
faces of wounds, of a pseudo-membrane composed of 
exudated fibrin and epithelial cells, more or less or- 
ganized; that it is usually constitutional and when so 
more or less asthenic. 

The question is often asked, is diphtheria primarily, 
a local or constitutional disease? I believe that 
the poison enters the system through the medium of 
a denuded surface, and therefore, like syphilis there 
must be a primary inoculation. 

In the majority of cases which begin with more or 
less fever, lassitude and general constitutional disturb- 
ance lasting for several days without local symptoms, 
we might incline to the opinion that the disease is 
here primarily, constitutional. However, it is pro- 
bable that some hidden part of a mucous surface was 
the seat of the deposit and the " port of entry " for 
the disease. The discussion on this point, like that 



regarding the local or constitutional origin of cancer, 
will probably go on indefinitely, but it indicates to 
us our duty in the matter of treatment, that is to in- 
clude in our therapeutics both local and constitutional 
measures. Much confusion obtains in the profession 
in regard to the nomenclature of disease. This is 
much to be regretted, but when we recall the fact of 
color blindness and the number afflicted with it, and 
their inability to appreciate the difference between 
the well defined colors green and red, we are not sur- 
prised that physicians vary in their interpretation of 
the symptoms of disease. 

This appreciation of the shades of color and symp- 
toms of disease, as the case may be, enters largely 
into the fitness of the worker in his particular field, 
and suggests the propriety of the government pro- 
tecting its people against the color-blind doctor, as 
well as against the color-blind marine pilot or rail- 
way engineer. 

In consideration of the above thought, I would 
advise against the multiplication of names of dis- 
eases, as I would against the adoption of a great 
variety of delicate colors for signal lights on account 
of the resultant confusion. In this connection, I de- 
sire to express my belief that the two affections 
laryngeal diphtheria and membranous croup are 
identical; the fact that such excellent observers as 
Frank, of Germany; Dr. Hiller, Dr. George John- 
son, Sir William Jenner and Morrell Mackenzie, of 



England, and our own Jacobi, of America, are of the 
same opinion, strengthens me in my belief. It is to 
be regretted that the term " diphtheritic sore throat" 
was ever introduced; it is misleading and incorrect. 
A disease is either diphtheria with which we have to 
cope, or it is not. One objection to the use of the 
term referred to, is the confusion it creates in the 
minds of our patients and the tendency it produces 
toward a contempt for the dangers of infection. 
There can be no question that some practitioners are 
either too liberal or too severe in their interpretation 
of the symptoms of disease. If during a season 
when our own knowledge and the records of the 
health department as well, testify that diphtheria is 
not prevalent in the community, we hear a physician 
say " I have had fifty or a hundred cases of diphtheria 
in the past month and have not lost a case," can we 
not conclude that he is what we may term " a liberal 
interpreter of the symptoms of disease," and possibly 
honestly (?) so. 

Again in a season when we know from evidence 
that cannot be questioned, that diphtheria is around 
us almost in an epidemic form, we hear a professional 
brother say "diphtheria can not be prevalent, I 
haven't a single case. These doctors who have them 
in abundance, are making them by exaggerating their 
tonsillitis and pharyngitis and ulcerated sore throat, 
and beside the fact that their cases get well, is evidence 
that they are not diphtheria, as that is a disease 



— 89 — 

which generally kills." — What must we think? Are 
we not justified in concluding that our brother is too 
severe in his conception of the disease? Might he 
not as well say that unless a case presents all of the 
most violent features of malignant scarlet fever, it is 
not that disease? All authorities and observers agree 
that individual cases and particularly epidemics vary 
in intensity and malignancy, but all are of sufficient 
importance to receive prompt, efficient and constant 
attention. No case of diphtheria, as well as no case 
of scarlet fever, can be mild enough to be free from 
danger, and all are treacherous. 

Some authorities favor the parasitic theory of the 
disease; others oppose it. We know this however, 
that the exudation is capable of rapid extension, and 
of infecting other surfaces, and that there are agents 
which, if brought into contact with it, will render it 
innocuous. This being the case, our duty is plain. 

Henle, Schwann, Hueter, Tommasi, Oertel and 
others have given strong proof in favor of diphtheria 
being due to bacteria. Eberth made successful in- 
oculation upon living tissues with bacteria which he 
had isolated, and, in the pointed language of Jacobi, 
" he asserts, with the positiveness of an evangelist, 
that diphtheria cannot occur without bacteria." 

As with all other questions, there are many who 
take a negative position, among them being Billroth, 
Hiller, Ehrlich, Curtis, Satterthwaite and H. C. 
Wood. Some are inclined to look upon bacteria as 



— 90 — 

an effect of the disease rather than the cause, among 
them Burton Sanderson. These pathological conun- 
drums, questions of identity or non-identity of 
poisons, germs, theories, etc., are alluring, but that 
which practically concerns us is the protection of the 
community against the disease, and the successful 
treatment of the same. Of nearly one hundred 
medical journals both foreign and domestic, which 
have come under my observation each month during 
the past several years, there has hardly been an issue 
which has not contained numerous suggestions regard- 
ing the treatment of diphtheria. Even the secular 
journals are not considered abreast of the times un- 
less their various numbers present formulae for the 
suppression of the disease. I believe the changes 
are more frequently rung on sulphur than any other 
one remedy by lay journals. An exhaustive reading 
of the literature of the subject in text books and 
journals for the past fifteen years, coupled with my 
experience and application of ideas gleaned from all 
sources, convinces me that the treatment should be 
supporting, antiseptic and eliminative. We should 
not forget that empty and hungry lymph vessels, 
not furnished with nutritive fluids, will absorb 
"locally-existing poisonous matters" as "a cat laps 
milk." 

Let us then make it our business, in each and every 
suspected case, to furnish starving tissues and empty 
lymphatic vessels with food that can be easily assimi- 



— 91 — 

lated, at the same time, earnestly devote our time and 
attention to the rendering of the " locally-existing 
poisonous substances" as nearly inert as we can, 
never forgetting that on general principles, and in 
this condition particularly, effete matter, products of 
diseases, the ashes of combustion, if you please, must 
not be permitted to accumulate. The excretory sys- 
tem must be stimulated, the animated system of 
sewerage must be cleansed and kept open. I have 
used the term " suspected case " advisedly, for, during 
the time when diphtheria is at all prevalent, every 
case of sore throat, in children particularly, should 
be suspected, isolation insisted upon and the severest 
precautionary measures adopted. We need not be 
alarmists, but we should always be upon the safe side, 
protecting our patients, anticipating dangers, and 
never caught napping. Never more than in the prac- 
tice of medicine is it true that " eternal vigilance is 
the price of safety." The emphatic words of one of 
our most earnest, energetic and efficient medical 
writers, should never cease to ring in our ears " Only 
the philosopher may be a passive spectator, the phy- 
sician must be a guardian." We should advise our 
patients, particularly during the prevalence of an 
epidemic, of the importance of giving proper atten- 
tion to all complaints on the part of the children, and 
the frequent examination of the throat, even though 
no trouble is complained of in that locality, should 
be practiced. Treatment should be instituted at the 



— 92 — 

earliest possible moment, and it should be positively 
and radically antagonistic to diphtheria, even though 
the symptoms be not well-defined; the patient should 
receive the benefit of the doubt. 

The isolation of our patient and his disinfection 
and that of his surroundings should be complete. 
The best disinfectant for soiled vessels and sewers, is 
a solution of common copperas, one pound to the gal- 
lon of water ; beside being efficient it is cheap. The 
most desirable for clothing, bed-linen, etc., is four 
ounces of sulphate of zinc and two ounces of common 
salt to the gallon of water. Carbolic acid is objec- 
tionable in that it must be used strong to be efficient, 
and by its all-pervading odor, it gives a false sense 
of security. For the purifications of the sick-rooms 
nothing equals fresh air, cleanliness and sunshine. 
For nutrition, peptonized milk alternated with beef 
peptonoids and a solution of the white of an egg in a 
half pint of water, are to be preferred. The milk in 
this form, is well borne by the stomach, and readily 
assimilated, and being alkaline it is very soothing to 
the sensitive surfaces of the mouth and throat. In 
fact, I find an occasional gargling of the throat with 
equal parts of lime-water and milk, made comforta- 
bly hot, or ice cold as the case may be, a good way 
to relieve the pain of the inflamed surface. 

The solution of albumen referred to, if carefully 
prepared, can be given freely, and children will not 
be able to distinguish it from plain cold water. In 



— 93 — 

addition to nutrition, I would positively urge active 
stimulation, and I consider alcohol the most desirable 
of diffusible stimulants. I make it the rule to give 
good brandy or whiskey liberally. Get the best 
liquor obtainable, for there is great risk in freely 
administering bad whiskey. I would fight the acute 
and infectious diseases, much as I would snake-bite, 
and it is astonishing what enormous quantities will 
be well borne in these conditions. I cannot express 
my convictions better than by quoting Jacobi who 
says, in Pepper's System of Medicine : " In regard to 
the dose of stimulants, it is a fact that there is more 
danger in diphtheria from giving too little than too 
much. When the pulse barely begins to be small 
and frequent, stimulants must be administered at 
once. A three year old child can comfortably take 
one to five ounces of cognac, or fifteen to seventy -five 
grains of carbonate of ammonia, or fifteen grains of 
musk or camphor and more in twenty-four hours. 
In the septic forms especially, the intoxicating ac- 
tion of alcohol is out of the question; the pulse be- 
comes stronger and slower, and the patient enjoys 
rest. In those cases in which the pulse is slow r , 
together with a weak heart's action the dose can 
hardly be too large. The fear of a bold administra- 
tion of stimulants will vanish, as does that of the use 
of large doses of opium in peritonitis, of quinia in 
pneumonia, or of iodide of potasium in meningitis or 
syphilis. I know that cases of young children with 



— 94 — 

general sepsis commenced immediately to improve 
when their three fluid ounces of brandy were increased 
to four times that amount in a day. " I have fre- 
quently found puny children, when the septic con- 
dition was excessive, the pulse almost imperceptible, 
restlessness acute and painful, improve as by magic 
under the administration of an ounce of whiskey 
or good brandy every hour till an effect was pro- 
duced. In this connection, I cannot refrain from 
referring to the personal experience of a medical 
friend in St. Louis, who contracted diphtheria 
while in attendance upon a malignant case. He 
stated that he applied local and general measures to 
his case, but that he supplied himself with the best 
whiskey that could be gotten and drank it in enor- 
mous quantities, keeping himself saturated with it, 
and the amount he took without producing intoxica- 
tion, was marvellous. The effect and the result in- 
creased his confidence in alcoholic stimulation. 

In the matter of medicinal treatment I am much 
inclined to germicidal and eliminative measures. 
Locally we should endeavor to relieve irritation and 
add to the comfort of our patients, at the same time, 
endeavor to prevent the spread of the membrane and 
render it innocuous while in situ or after exfoliation. 
I am disposed to fear the possibility of the infectious 
matter inoculating the alimentary canal if swallowed, 
(doubting the statement that has been made that the 



— 95 — 

gastric juice renders the membrane inert) and also 
poisoning the blood by absorption. 

The two remedies upon which I chiefly rely are 
the bichloride of mercury and the benzoate of soda. 
The mecurial treatment of diphtheria was practiced, 
possibly empirically, many years ago, at least as 
early as 179V, and from time to time since has been 
prevalent, the usual form of administration being 
calomel. For five years past, I have used the cor- 
rosive sublimate in doses from the one-fiftieth to 
the one-hundredth of a grain every hour or two, ac- 
cording to age or condition, preceded by large quan- 
tities of water ; I gave the mercury in this form for 
the reason that it was easy of administration ; it 
acted as a germicide locally and constitutionally, and 
was a stimulant to the eliminative organs, as well as 
a preventive of fibrinous exudations in that it defi- 
brinated the blood. In addition, it has been my cus- 
tom to give the benzoate of soda in doses of five, ten 
or fifteen grains, every hour or two according to age 
or condition. I cannot better present my reason for 
the administration of this drug, than by quoting from 
a paper read before the St. Louis Medical Society in 
February, 1886, on scarlet fever, viz., "The remedy 
upon which I chiefly rely in my infectious cases is 
the benzoate of soda. I may safely say that I proba- 
bly never prescribed for a case of scarlet fever dur- 
ing the early stages, without giving this remedy. 
In 1879 Salkowski showed that this drug largely in- 



— 90 — 

creases the secretion of nitrogenous and sulphurous 
compounds with the urine, and drew the conclusion 
that it should be useful in diseases in which the blood 
is overcharged with effete matters. 

Salkowski, Fleck and Buckholtz discovered that 
the benzoate of soda prevents the development of 
bacteria in putrescible liquids, and Graham Brown 
found that diphtheritic fluids lose their contagious 
quality speedily in a solution of benzoate of soda. 
The remedy also, in my judgment, reduces tempera- 
ture. It may be given in from ten to fifteen grain 
doses, in syrup and cinnamon water, every hour or 
two, to a child from two to live years of age. The 
mixture is a very pleasant one. " Dr. A. Broudel 
writes, in the Bulletin General de Titer apeutique, 
of November 15, 1886, concerning the treatment 
of diphtheria by benzoate of soda, and asserts that 
of two hundred consecutive cases he has not lost 
a single one. He admits the possibility of a mistaken 
diagnosis in some instances, and^ I am inclined to 
think the admission a very proper one, but even ex- 
cluding fifty per cent, on that account, he still has a 
large number of cases without a death. Here, then, 
we have two remedies, both of which act locally and 
constitutionally as destroyers of bacteria and stimu- 
lants to the excretory system, thus ridding the over- 
charged blood of its effete matter. In mild cases, 
with a limited patch of membrane, and severe cases 
with an extensive deposit, the membrane will soften, 



liquefy, and gradually be thrown off, and be much 
less disposed to spread or reform than under other 
plans of treatment. I have, since November, 1884, 
given no quinine and iron, except in the period of 
convalescence, as a tonic; and absolutely no chlorate 
of potash, believing that it is frequently productive 
of harm, and of all remedies probably more abused 
by the laity and the profession than any save quinine. 
As a local application, Marchand's peroxide of hydro- 
gen, full strength, either applied by means of an 
atomizer or a swab, stands pre-eminent. If the child 
is old enough he may use it as a gargle, or the part 
may be flushed with a syringe. The peroxide is a 
rapid oxidizer, and under its use a thick, tenacious 
membrane of diphtheria will disintegrate, as melts 
the snow under the warming rays of the noonday 
sun. Now and then the local application of oil of 
turpentine to the pharynygeal surface is indicated, 
and a more healthful application to a mucous surface 
was never made, and as a diffusible stimulant, and an 
accelerator of the glandular system, nothing is bet- 
ter. The bichloride and benzoate of soda, as admin- 
istered above, are admirably successful in controlling 
and relieving doubtful cases, which never advance 
further than being tonsillitis or ulcerated sore throat. 

I present the following conclusions: 

1. In the management of diphtheria, nutrition, 
stimulation, antisepsis and elimination are the most 
potent means of antagonism. 

7 



— 98 — 

2. The nourishment should be of a character to be 
readily assimilated, and in the majority of cases 
should be peptonized. 

3. Good whiskey or brandy as diffusible stimulants 
are to be preferred. 

4. The bichloride of mercury, in small doses, fre- 
quently administered, accompanied with liberal quan- 
tities of water, coupled with the benzoate of soda, 
are the most reliable antiseptics and glandular stimu- 
lants at our command. 

5. Too great stress cannot be given to the sodium 
benzoate as a local and constitutional measure. 

6. As a local application, Marchand's peroxide of 
hydrogen is as reliable in its destructiveness to the 
membrane as is water to fire. It may be applied 
freely, and if swallowed no barm is done. 

7. As a disinfectant to the air of the room, and a 
soother and softener of the dry and sensitive air pas- 
sages, equal parts of tar and turpentine may be 
boiled freely in the sick room, in proportion of two 
ounces of each to a quart of hot water. 



EXANTHEMATOUS FEVERS. 

There are certain general points which will apply- 
to all of the fevers of this group. We must remem- 
ber that we have a specific germ, which probably 
enters the circulation, and in its efforts, or rather, in 
the effort of nature to throw off the disease, we 
have the rash developed upon the skin. We must re- 
member that the skin is but a continuation of the lin- 
ing membranes of the body, and that naturally we 
have by a continuity of surface an irritation of all the 
lining membranes, if not a perfect rash, in harmony 
with that which is upon the surfaces. In a general way 
our treatment should be directed towards maintain- 
ing the equilibrium of all the secretions of the body. 
If there be enough irritation connected with any par- 
ticular part of the glandular system, we should re- 
lieve the special organ and stimulate the activity of 
the remaining ones. If, for instance, the skin be 
greatly involved, and there be much inflammatory 
action accompanying the rash, we should be all the 
more active in keeping open the compensatory organs, 
such as the bowels and the kidneys, or if the kidneys 
be engorged, and their activities impaired, we should 
stimulate the glandular attachments of the skin to 
compensatory work. An open condition of the ex- 
cretory organs should be maintained, with a view of 



— 100 — 

aiding nature to eliminate the poison, and a counter 
activity of certain other organs should be urged, 
which will relieve those which are crippled. A part 
of the expression of the disease is always more or 
less irritation of the skin. Sometimes this is so pro- 
nounced as to produce a marked irritative fever. 
Our efforts should be turned towards soothing this 
irritation. Time was when scarlet-fever patients and 
the victims of measles were permitted not only to 
almost burn up from thirst, but the burning process 
was stimulated by the application of external warmth 
and the maintenance of a heated condition of the air 
in the room of the patient. Now ; however, we ap- 
preciate the value of comforting our patient, while 
guarding against any chilling of the surfaces, we 
admit cooling drinks freely, and are even willing at 
times to sponge off the surfaces of the body for the 
cooling effect produced. We are all of us every now 
and then called to victims of measles and scarlet 
fever (with a temperature much beyond 105°, a burn- 
ing thirst, a feeling all over the snrfaces as thou h 
the parts were on tire), covered mountain-high with 
bed clothing, and denied any form of drink whatso- 
ever. The gratitude of the patient who is relieved 
from such inhuman treatment can well be imagined. 
The drinking of cold water under these conditions, 
given in the name of humanity, the removal of all 
excessive bed-clothing, and the administration of 



— 101 — 

remedies which reduce the temperature, are surely 
most grateful. 

Scarlet Fever is a disease which is dreaded more, 
and justly so, by the thoughtful mother than almost 
any other disease upon the list, unless it be diphthe- 
ria. It is the most uniformly uncertain and variable 
in its expressions of any of the diseases of childhood. 
It is as variable as the individual. No two cases 
during any particular epidemic will pursue the same 
course; no two epidemics will be alike. We may 
pass through a series of years during which we will 
have observed a large number of cases of scarlet 
fever, all of which were amenable to treatment and 
terminated favorably, without complications. ILour 
experience be limited, we shall probably form the 
opinion that scarlet fever is not much of a disease 
after all, or else we are particularly skillful in its 
management; but the truth is, before we have hardly 
gotten through with the indulgence of this thought, 
one or more cases will come under observation which 
will demoralize us completely. In other words, the 
expression of the disease seems to vary during differ- 
ent seasons. Many epidemics are mild, while others 
are malignant, but no case of scarlet fever, however 
mild, should be looked upon as a trivial disease. The 
simplest case, with the temperature but little above 
the normal, with a rash that is hardly perceptible, 
with a sore throat which it is almost impossible to 
discover, the child disposed to play around the room 



— 102 — 

and hardly realizing that it is sick, if neglected, 
may suddenly develop symptoms most dangerous. 
I have heard observers give expression to the thought 
that the simplest and mildest cases of scarlet fever 
Avere most liable to complications deadly and danger- 
ous, the explanation being given that the disease not 
having expressed itself in the most tangible way, was 
indulging its deadly work in secret; yet I believe that 
this is not the correct view to take. The more severe 
the expression of a case of scarlet fever, the higher the 
temperature, the greater the amount of local disturb- 
ance upon the skin, as a rule, the greater the danger 
of complications. The reason that the seemingly 
mild case's are so frequently complicated with later 
dangers is that they are neglected. Of several chil- 
dren in the family taken down with scarlet fever, 
the one which is seemingly the most seriously ill will 
receive the most attention; the mild case will more 
than likely be neglected. I have observed in St. 
Louis, where the law, which is very explicit, requiring 
that every house in which a case of scarlet fever oc- 
curs shall be placarded, that many times the mild 
case of scarlet fever is visited only for two or three 
days, and the house is not placarded at all, and the 
parents, in blissful ignorance, fail to guard the child 
from danger. We should impress the parents of the 
child with the fact that no matter how seemingly 
mild a case of scarlet fever may be, it is in every de- 
tail a serious and very dangerous disease. If a child 



— 103 — 

has scarlet fever at all, mildly or severely, it is in for 
a siege of not less than six weeks. As when called 
to a broken leg, we should say " This case will re- 
quire six or eight weeks of guarding and attention. 
The most that we can do is to help nature to heal it- 
self." We should call from time to time and guard the 
patient from complications, but under no circum- 
stances should the parent be led to believe that the 
child is out of danger until at least six weeks have 
elapsed from the time of the appearance of the rash. 
One of the most frequent complications of scarlet 
fever is nephritis, so we should be constantly on the 
qui vive and watch closely the secretion from the 
kidney and from time to time administer the appro- 
priate remedies for flushing and washing out the 
same, and to this end the administration now and 
then of water-melon seed tea is of value. I consider 
the benzoate of soda one of the most valuable reme- 
dies to administer to scarlet fever patients; given 
in ten-grain doses every one or two hours, as the case 
may be, from the beginning, we shall secure an open 
condition of the excretory organs. The temperature 
sometimes goes very high, and in such conditions it 
should be reduced. Acetanilid in three to five-grain 
doses every two to four hours, given in the follow- 
ing formula, is valuable: 



104 



ft. 


Acetanilid, 


gr. xl. 




Alcohol, 


3iv. 




Glycerin, 


3iv. 




Pepsin cordial (P., D. & Co.), 


fiij. 



M. Sig. : Dessertspoonful every two to four hours, with a 
view to holding the temperature down to 102. 

This formula is not only of service in reducing the 
temperature, but secures tranquility to the nervous 
system of the patient. 

The sore throat in scarlet fever is sometimes quite 
distressing, and remedies which sooth and are cleans- 
ing should be used. The following gargle is of 
value: 

Fid. extract harnarnelis (P., D. & Co.), I i. 

Tr. calendula, 3ij. 

Boro-glycerid (50 per cent.), 3 vj. 

Aqua rosa, 5 vi. 
M. 

The same may be used in the atomizer at least once 
every two or three hours, and free flushing of the in- 
flamed parts, either by gargling or by spraying, 
should be made with Marchand's "peroxide of hydro- 
gen. 

While there is often a disposition to necrosis of 
tissues in the sore throat of scarlet fever, producing 
a condition simulating the membrane of diphtheria, 
yet we frequently have diphtheria as a complication; 
in fact whether there be any sympathetic relation- 
ship existing between the germs of scarlet fever and 
diphtheria or not, the fact remains that we often have 
scarlet fever sore throat plus diphtheria. The condi- 



— 105 — 

tions of system present in a case of scarlet fever, as 
well as the local condition, all cordially invite the 
visitation of the diphtheria germ. For this reason I 
feel that we should be ever on the alert in guarding 
against this possible complication. 

Personal Disinfection ix Scarlet Fever. — 
Since we know that scarlet fever is so actively con- 
tagious, and that all of the discharges and materials 
thrown off from the surface are active carriers of 
the virus, we should be on the lookout, guarding 
others against possible infection from the particular 
individual under our care. All the vessels which are 
used about the sick room should be disinfected, and 
for this purpose we have nothing more convenient 
or advantageous than Piatt's chlorides in varying 
strength, or we may use the disinfectants suggested 
for diphtheria. We can make such a solution as we 
may wish, and wash out the various utensils used in 
the sick room. Realizing that the desquamative 
stage of the disease is the one when contagion is 
most active, we should from the start sponge the sur- 
face of our patient with antiseptic lotions. An anti- 
septic cologne has been furnished, which is bichloride 
of mercury one part to two thousand of cologne. 
Freely sponging off with this is not only agreeable to 
the patient, but tends in the direction of the destruc- 
tion of the contagious element. Another application 
which is also in the same direction, and at the same 
time of excellent advantage in soothing the intense 



— 106 — 

itching of the skin which is sometimes present, is 
the following : 

Acid Carbolic, gr. xxx. 

Liquid Albolene, $ vi. 

M. Sig. : Apply once or twice daily. 

We are perfectly safe in commending a thorough 
washing of the surfaces every second or third day 
with hot water and castile soap. We will often find 
the attendants very much averse to changing the 
clothing or cleansing the surfaces. I have many times 
seen a victim of scarlet fever in the third or fourth 
week to whom a drop of water had hardly ever been 
given internally, and none had been applied exter- 
nally, and whose bed clothing had never been 
changed ; burning with thirst, secretions all checked 
by accumulated dried epithelium and general filth. 
Here was a case indeed which called for sympathy 
and sanitation. We are safe in informing the atten- 
dants that not only in these cases, but in all other 
cases of sickness, if there be no draft allowed or chill- 
ing of the surface, that is if the room be kept prop- 
erly warmed, and all openings guarded, any patient 
may be safely washed ; in fact they are the better 
for it. More than that, any patient, whether suffer- 
ing from scarlet fever or what not, is the better for 
drinking freely of good, pure water. Of course 
there are times when the stomach will reject abun- 
dant quantities of water, but with proper precaution 
cool water, not too cold, but just cold enough, may 



— 107 — 

safely be given to nearly all patients, and certainly 
to none more than to the victims of scarlet fever. 
There are many accumulated poisons in the system 
which require a free flushing of water to carry them 
out. The demands of a proper elimination, of a 
proper cleansing of the alimentary canal, of a proper 
assimilation of food, of a proper reconstruction of 
tissue, are in the direction of a free supply of good, 
pure water. 



MEASLES. 

In measles the complications are more frequent in 
the direction of the air passages, and in the later 
stages sometimes toward the alimentary canal; for- 
tunately the kidneys are not so frequently involved. 
Conversation with those adults who have suffered 
from measles convinces me that the discomforts of 
the disease are much more severe than are generally 
supposed. Too often the family rest under the im- 
pression that measles is a trivial disease, and that 
they can cope with, the majority of cases successfully 
without the aid of a physician. I recall a case of a 
little girl of twelve, the youngest child, reared in a 
lap of luxury, who had been sick for a week with 
measles, and the family physician had administered 
the old-time hot drinks ad nauseum. The child was 
almost frantic, had rested neither day or night for a 
week, at least, only at intervals, and then only from 
exhaustion. The thermometer indicated a tempera- 
ture of nearly 106°, a persistent cough was present, 
and every now and then an irritability of the stom- 
ach, which was probably superinduced by the cough- 



ng. 1 administered the following: 




I£ Acetanilid, 


gr. xl, 


Alcohol, 


3ij- 


Glycerin, 


3ij- 


Aquae Cinnamoni, 


5jss. 


M. Sig.: Dessertspoonful every two hours. 





— 109 — 

A sponging off of the surface, and to relieve the 
intolerable itching the following: 

5 Fid. ext. hamamelis (P., D. & Co.). 1J- 

Acid boracic (impalpable powder), 3 iij. 

Glycerin, lj. 

Aquserosae, ^ 5 V J- 

M. Sig. : Apply every four to six hours. 

Directed that cooling drinks be given in small 
quantities ad libitum. After sponging of the surfaces 
and the second dose of the medicine the child went 
to sleep, and slept all night, the first night since the 
beginning of the attack. She called for the sponging 
off in the morning, and stated after receiving it that 
she for the first time felt that she was not in a bake 
oven being blistered. A little bland soup was given 
in the morning, and a few hours later she was de- 
lighted by being informed that she could have a little 
ice cream. At no time later was her temperature 
permitted to go above 102. The cough almost 
entirely disappeared with the subsidence of the 
fever. She remained in a thoroughly comfortably 
condition, and inside of three or four days was 
convalescing. The point I would make in this 
case is that many times, with a sensitive skin, 
and a correspondingly sensitive mucous membrane, a 
case of measles may cause intolerable anguish, and 
even great danger, and we have the means at our 
command for reducing the discomforts and mitigat- 
ing the danger, and should avail ourselves of them. 



— 110 — 

In the several coal tar products we have the means of 
rendering our cases of measles all more mild; of soft- 
ening the asperities of the situation. 

German Measles has received more attention 
during the past ten years than previously in this coun- 
try. It is a a distinct disease in itself. No doubt 
many times it has been mistaken for scarlet fever 
in some cases, and in others for rubeola. It resem- 
bles scarlet fever, in that there is some soreness of 
the fauces generally present. The rash is less soli- 
tary in its character, and less bluish, than in measles, 
being in some cases more disposed to simulate the 
rash of scarlet fever. We should never be too posi- 
tive in our diagnosis. If we be in doubt as to the 
character of the rash, we should not hesitate to say 
so. Let us frankly tell our patient that the case is 
not completely developed; that it presents certain 
symptoms which point in a certain direction, and as 
the picture more completely unfolds itself, we shall 
announce it. We are always safe in giving the other 
members of the family the benefit of the doubt. If 
we have a case which tends in the direction of any of 
the contagious diseases, we should insist upon isola- 
tion, and if the case should not develop in any par- 
ticular direction, there is no harm done. There are 
certain general principles which will apply to the 
management of these eruptive fevers. We are safe 
always in holding down the temperature, comforting 
our patient and keeping open the secretions, and 



— Ill — 

whether the case be German measles, rubeola, or scar- 
let fever, matters not, if we are attentive and watch- 
ful and have our patient isolated. I believe that 
physicians frequently err in the direction of making 
too hasty a diagnosis, and then hate to change it. 
They do not mean to be dishonest, in fact they pro- 
bably are not; they try to believe that they were 
right. We are always safe in pursuing a careful and 
conservative course; let us do always with the patient 
as we should wish a member of our own family 
treated. If we pursue this course we are safe. We 
need not be afraid to tell the family that we have 
not surely made the diagnosis, and that we are simply 
watching the case, and as it develops will announce 
our opinion. Let us ask their co-operation in the di- 
rection of observing symptoms. We shall often get 
good service from a mother if we suggest that she 
take a sheet of paper and note down from time to 
time with pencil the symptoms as observed. 



CHICKEN POX. 

Chicken pox is a disease to which the physician is 
rarely called. The majority of cases are carried 
through by the home circle, without our help. Some- 
times, however, there is some special condition of the 
system which tends in the direction of aggravating 
the disease and producing a suppurative disposition 
upon the part of the papules, and we are then sum- 
moned. An open condition of the alimentary canal 
should be insisted upon in this disease, and a mild 
diet directed, as anything which causes irritation of 
the alimentary canal is reflected by an increased irri- 
tation in the irritated parts of the skin. If there be 
any itching, a sponging off with the lotion mentioned 
in the remarks upon measles will be of value. If 
the pustules are indisposed to heal immediately, the 
application of the standard benzoated oxide of zinc 
ointment, to which five grains of carbolic acid may 
be added, will be beneficial. 



WHOOPING COUGH. 

Whooping cough is a disease which has been sup- 
posed to be trivial in its character by the laity, and 
to rarely require medical aid, but in my judgment 
this is a great mistake. Whooping cough is a very 
serious disease. Anything which produces the 
amount of local irritation that whooping cough does, 
together with the serious demoralization of the nerv- 
ous system, the impairment of nutrition, the loss of 
weight, is dangerous; besides, statistics will prove 
that if many cases are not directly fatal, they are in- 
directly so from the complications which may follow. 
If we have the opportunity to influence the parent of 
the child, we should impress her with the fact that 
whooping cough is a serious disease; that the general 
impression which has obtained that it is not ame- 
nable to treatment is a mistake, but that it may be 
very materially mitigated in its severity, the discom- 
forts greatly relieved, and the length of the attack 
shortened. There is nearly always a preliminary 
period of bronchial irritation, with some fever, before 
the paroxysms or spasms become fully initiated. If 
the child be well advanced in years, it can wrestle 
with these paroxysms to fairly good advantage, but 
if it is young, they are indeed distressing. Recent 
developments tend to establish the thought that there 



— 114 — 

is some specific germ causing pertussis, which enters 
through the air passages, chiefly the nose. This be- 
ing so, it has been positively demonstrated that 
remedies in the nature of germicides applied to the 
nasal passages seemingly have an effect in reducing 
the number of paroxysms. I have had a number of 
cases in which I have used three and four times a day 
a liberal spray of Marchand's peroxide of hydrogen 
through the nasal passages. In older children I did 
not hesitate to use the syringe, and in them the 
strength used was the undiluted; for smaller children 
it should be diluted to about one part to three of 
water. When we recall the number of cases of par- 
oxysmal laryngeal cough, spasmodic asthma, which 
have been relieved by the application of remedies 
applied to the posterior nares, we can appreciate the 
relations between these parts and these spasmodic 
seizures in whooping cough. My attention was first 
directed to the value of local ^applications such as 
have been mentioned in the treatment of whooping 
cough by a sufferer from apparent laryngeal irritation, 
the victim having attacks every half hour or hour, 
which were almost uncontrollable, and which were 
at times almost suggestive of spasmodic asthma. 
These were relieved almost entirely by the applica- 
tion to the posterior nares of ten grains of nitrate of 
silver in an ounce of glycerin, applied with a brush. 
For days previously the victim had had applied di- 
rectly to his larynx a series of applications which 



— 115 — 

were absolutely without service. His trouble was a 
reflex asthma, the primary irritation being in the pos- 
terior nares. Such cases also as pass under the name 
of hay fever, which are similar in their character, 
and are relieved sometimes by local applications in 
the nose, are a full justification for the treatment of 
whooping cough through the same channel. As a 
controller of the paroxysms, we have in acetanilid 
(two and one-half to five grains every two to four 
hours), a good remedy. The paroxysms can be re- 
duced at least threefold, and a comparative degree 
of comfort can be maintained. Not only so, but the 
length of the attacks is abbreviated in many cases. 
The repeated paroxysms in whooping cough result in 
vomiting— complete loss of the contents of the stomach. 
I should, however, insist upon the child eating right 
along, of course of the most digestible food; there is 
a satisfaction to the palate which accompanies eating, 
and a modicum of the food, at least, is retained 
and assimilated. I am satisfied that the individual is 
benefited who has his palate pleased by food at 
proper intervals, even if the same be rejected soon 
after. The psychical satisfaction produced by the 
meal is in itself of service to the patient. 

Inhalations of chloroform (fifteen or twenty drops 
poured upon a handkerchief and the child permitted 
to breathe it carefully) will sometimes mitigate the 
severity of paroxysms. I believe the mitigation of 
severity diminishes frequency. Prof. Hobart A. 



— 116 — 

Hare suggests in the severest cases the use very 
guardedly of inhalations of nitrite of amyl, two or 
three drops upon the hand or handkerchief of the at- 
tendant, placed in position to be breathed with an 
admixture of air. JBromoform, an agent compara- 
tively new, from a therapeutic standpoint, has been 
suggested for whooping cough. 

Dr. Krieger has recently reported in the Texas 
Courier of 31edicine (Jan., 1891), a number of cases 
successfully treated by this remedy. His method of 
administration has been to prescribe " one or two 
drachms pure, and give one to four drops in a tea- 
spoonful of milk three to five times a day, according 
to age and severity of disease, and, moreover, to give 
special instructions that the last remnant be given 
from the spoon, as bromoform does not mix, but sinks 
to the bottom. A happy feature is its sweetness." 

He claims that a majority of his cases were 
promptly controlled from the beginning and termin- 
ated favorably in from five to ten days. 



VACCINATION. 

If the child he reasonably healthy, vaccination 
should be performed when it is about three or four 
months old. It is better at this age than later, for 
it is more quiescent and passive, and less likely to 
irritate the " sore " by over-exertion. Fortunately 
for the benefit of humanity and the convenience of 
the profession, bovine virus is now cultivated in large 
quantities all over the country, and this is the only 
kind we should ever use. Under no circumstances 
should we take virus even one remove from the cow, 
as the possibilities of infection of other diseases from 
individual to individual should not be despised. The 
physician is remiss in his duty, if he does not urge 
upon the parent the importance of vaccination, and 
he should be willing at all times to take the respon- 
sibility of administering it. Unless there is some in- 
herent weakness in the blood of the child, there need 
be no fear indulged in connection with the procedure. 
My usual plan in vaccinating is to take the point of 
a dull knife and scrape rapidly the outer layer of the 
skin until the glistening, denuded surface appears. 
Blood will not usually follow. The quill upon which 
the virus has been deposited should then be mois- 
tened in a little water and briskly rubbed over the 
surface, and the part be allowed to completely dry. 



— 118 — 

Direct the mother to sew on the inside of the sleeve, 
particularly if it is flannel, a piece of soft linen, as it 
is more cooling to the part. No adhesive plaster nor 
other application should be made to the inoculated 
point. We should direct that the part be protected 
in every way possible, and the scab not allowed to 
be broken, as the breaking of the same extends the 
inoculation and increases the sore, without adding to 
its efficiency. Select a point upon the remote side 
of the arm about three inches below the insertion of 
the joint. Under no circumstances, even if the vic- 
tim be a girl, should we allow the leg to be chosen. 
The muscles of the leg are brought more freely into 
play, and the sore is likely to be much greater. Ma- 
ternal vanity should not fear the effect of a mild scar 
produced by the inoculation upon the arm. Even if 
the demands of society later in life require the expos- 
ure of the arm, the appearance there of a delicate 
white scar cannot be other than decorative, and to 
the medical mind it should be particularly gratify- 
ing as it stands out prominently as a tribute of so- 
ciety to science and the great Jenner. 



CONTI N UED FEVERS. 

There are various kinds of fevers among children, 
and whatever the cause, the disposition is to a contin- 
ued form of fever rather than to that which takes 
upon itself the intermittent character. 

Even if malaria be the exciting cause we do not 
have, so frequently as in adults, a well defined chill 
followed by fever of a very high grade and then an 
intermission, but are ranch more apt to have a mild 
expression of fever continuous in character. 

A heavy cold in the child, checking the secre- 
tions, directing the blood inwardly and congesting 
the internal organs, will develop a fever which may 
last for a number of days, and may even be so pro- 
nounced and dangerous as to cause death early. 

In such cases our diagnosis could probably be 
safely made, " Congestive fever." 

The one element that is to be always considered in 
childhood, is the nervous system. From infancy up 
to the complete development the nerve centers are 
more or less delicate and susceptible to external in- 
fluences. 

This fact it is which gives many infantile diseases 
which would otherwise be trivial in character a seri- 
ous aspect. 

Delicate nerve centers, a soft and pliable brain, it is 



— 120 — 

true may at times bear injury produced by external 
violence wonderfully well, and yet that same brain, 
in consideration of its unorganized, uncertain sus- 
ceptibilities may be completely demoralized and de- 
stroyed by a congestion which adults would bear 
easily and well. 

There are certain general principles to be observed 
in the management of the fevers of children which 
will apply in all cases no matter what the cause, 
whether it be congestion or so-called malaria. 

In this connection I would say that I believe 
seventy-five per cent, of the so-called malarial fevers 
are not such, but only a disturbed condition of the 
circulatory apparatus and nerve centers, with an ac- 
companying accumulation of excretory matter that 
should have been eliminated, caused by chilling of 
the surface from insufficient clothing and exjiosure 
to variations of temperature. 

There may be a malarial germ which is at the bot- 
tom of the so-called malarial feve,r, but so far as my 
observation extends, I believe that the sufferers in 
the greater bulk of the so-called malarial cases are 
simply the victims of taking cold. 

There is an exposed surface, the blood is driven 
inwardly toward the liver, the lungs, the spleen and 
the digestive apparatus ; a general riot results, fever 
is developed and we term it "Malaria." 

It matters not, however, what term we apply; we 
have a condition to meet and the best way in which 



— 121 — 

to meet it is to produce upon the part of the body 
affected a reverse tendency; to open up all the secre- 
tions as far as possible; to bring the blood to the 
surface; and to tranquilize the disturbed nerve cen- 
ters. 

The only indication which justifies the thought in 
the direction of some special malarial germ is the 
feature of periodicity. In children this periodicity 
is not so marked. 

If called to a case of fever in a child, we shall gen- 
erally find a coated tongue and evidence of impaired 
digestion, with more or less tenderness over the 
stomach and bowels. 

We find frequently in infants, that bronchitis is 
present. The first important thing to do is to arouse 
all the excretory organs. The bowels may be thor- 
oughly open, and yet the various excretory glands 
connected with the intestinal canal may not be active. 

To simply ask the parent if the child's bowels are 
open is not sufficient. The evacuation should be seen 
and closely scrutinized and the doctor should not 
hesitate to use his nose as well as his eyes. 

The odor very often determines the condition of 
the alimentary canal. There is nearly always a per- 
verted secretion ; a disposition to decomposition 
evinced by the odor, or else a thoroughly torpid, in- 
active state evinced by the absence of odor. 

A thorough cleaning out of the alimentary canal 
by means of one grain doses of mild chloride, re- 



— 122 — 

peated every two hours, until a complete response is 
secured, should be followed by broken doses for a 
day or two to keep up the activity of glandular 
action, the one-tenth to the one-eighth of a grain of 
of the same drug being given every two to four 
hours. 

Of course the temperature should be determined 
promptly and if high it should be immediately re- 
duced, because high temperatures long continued are 
dangerous; the most prompt means of reducing a 
dangerously high temperature is the cooling bath. 

A visit should be made within twelve hours to de- 
termine whether the fever is still present or not. 
Cases of cold and acute indigestion, produced by 
improper food, or a cold received immediately after 
eating, creating a congestion in the neighborhood 
of the stomach and an interference with digestion 
may oftentimes be relieved by a simple clearing out 
of the alimentary canal. 

The subsequent treatment requisite in such cases is 
a proper selection of a mild diet for several days and 
protection against chilling of the surfaces. 

If we discover, however, that in spite of the efforts 
made to remove the cause, we still have a fever 
present and that it is disposed to continue, we should 
provide for a gentle siege of longer or shorter dura- 
tion as the case may be. 

Of course we shall keep ever in mind the possibili- 
ties of malaria and the administration of quinine 



— 123 — 

should be early instituted, after the conditions shall 
have been made favorable to its reception. 

It goes without saying that any remedy which it 
is desired should be thoroughly absorbed, should not 
be given until the stomach and alimentary canal are 
in proper shape for its reception. 

On general principles, therefore, the clearing out 
of the stomach and bowels, placing the absorbents in 
a receptive attitude should be accomplished, before 
exhibiting quinine. 

Controlling Temperature. — It should not be 
our desire to reduce the temperature of a fever pa- 
tient too rapidly or too constantly, or to too great a 
degree. 

A temperature of 102 is not dangerous. If it goes 
higher, however, means should be instituted by 
which a reduction of one or two degrees may be 
secured. 

Of course, if the temperature runs up rapidly to 
104° or 105° or higher we should reduce it promptly, 
and the best means to this end is a cooling bath. 

Some writers favor a sudden immersion in very 
cold water. This is in the majority of cases, I think, 
unnecessarily severe, in fact considering the shock 
to an already demoralized nervous system, I think 
that a much more humane way for the administra- 
tion of the cooling bath is to immerse the child in 
water the temperature of the body, or even warmer, 
and then permit the heat to be gently reduced until 



— 124 — 

a proper degree of coolness is secured. It should be 
kept in the bath sufficiently long to bring the tem- 
perature down to a reasonable degree. 

In order to hold the temperature down for any pro- 
longed time it is questionable whether we should re- 
peat the bath often. 

To some patients the bath is grateful and conduc- 
ive only to good. To others the bath is demoralizing, 
a riot is created every time it is administered, and 
when such is the case, I am strong in the conviction 
that other means should be used. 

Many times the administration internally of febri- 
fuges may be alternated with the bath, and in this 
way the temperature may be much more easily con- 
trolled. 

I have under my care at this moment a child of 
seven, naturally amiable, a well controlled, well man- 
aged little girl, in health fond of her bath, but the 
very suggestion of a cooling bath or even of spong- 
ing of the surfaces arouses a cycjone of irritability, 
screaming, kicking and struggling to such a degree 
that the bath cannot be given. 

Unquestionably a hypersensitive nervous system, 
resulting from a high degree of fever, lias developed 
a special aversion to all form of water, applied 
locally; even a cold cloth to the head creates worry 
and annoyance. In this case, as in many others that 
have come under my observation, I have been forced 
to apply other means for reducing the temperature. 



— 125 — 

I am already on record as favoring the use of acet- 
anilid, in a paper read before the American Medical 
Association, at Newport, in June, 1889. 

I have not changed my views regarding the drug. 

To a child I administer a dose ranging from one to 
five grains, according to the age, using the following 
formula: 

3 Acetanilid, ^ dram. 

Vin Tokay (Calvico), J^ ounce. 

Pepsin Cordial (P., D. & Co.). 1^ ounces. 

M. Sig.: One to two teaspoonsful, every tvro to four hours 
according to age and intensity of fever. 

I prefer in the use of this drug, as in the use of all 
other agents for reducing temperature, to give an 
average dose and maintain the effect secured by a 
repetition of dose. 

I am not in favor of large antipyretic doses. 

Where too great a reduction is produced the reac- 
tion is all the greater and the depression is objection- 
able. 

As will be observed in the formula as given, I 
nearly always accompany the antipyretics with a 
small amount of alcoholic stimulation in order to 
overcome any possible depression. 

Some writers use analgesin in place of acetanilid. 

I am inclined to believe that analgesin is more 
depressing and that there is greater danger to the 
heart. 

I have had most excellent results in a small num- 



— 126 — 

ber of cases in the use of phenacetin in the place of 
acetanilid, as a reducer of temperature. 

The advantage of the coal tar products is that 
they, while reducing the temperature also tranquilize 
the nervous system and tend in the direction of rest 
and sleep, and at the same time they are undoubt- 
edly, to a degree, antiseptic to the alimentary canal. 

The position may be taken by some that fever is 
only a symptom of a condition and that by reducing 
the temperature we simply mask the condition. 

We might also say that pain in the stomach or 
bowels, or anywhere else is only a symptom indicat- 
ing a condition. 

None the less, we should relieve it, as the symptom, 
by effects produced, if long continued, may be de- 
moralizing and dangerous. 

High temperature long continued is dangerous. 
For these reasons I am strongly in favor of holding 
down the temperature. 

In all these continued fevers I believe that it should 
be our effort to manage our fever cases, rather than 
to medicate, and yet there are times when medicine 
serves us well. 

As a means of controlling temperature we have 
had added to our armamentarium valuable remedies 
in the coal tar series. With their aid, coupled with 
judicious bathing and proper efforts toward meeting 
the symptoms as they arise, these fevers have been 
robbed of many of their terrors. 



— 127 — 

There are three very important features which re. 
quire attention in fever cases: 

First; the keeping actively engaged the glandular 
system of the body, by which the waste products, 
resulting from combustion expressed by the fever, 
are carried away: 

Second; the proper tranquillization of the patient: 

Third; correct nutrition, tranquillity is largely 
assisted by measures which are applied for the reduc- 
tion of temperature, but in many cases additional 
efforts will be required. 

An abundance of sleep should be secured, and if it 
is not accomplished by remedies which have been 
given to reduce temperature there should be given, as 
may be indicated, small doses of chloral hydrate, 
from one to five grains, coupled with bromide of soda, 
five to fifteen grains, according to age. 

The best means of administering the combination is 
the following: 

5 Chloral Hydratis., 3 ss. 

Sod. Bromicl., 3 jss. 

Syr. Tolu, jy. 

M. Sig.: One or two teaspoonsful according to age or 
requirements until rest is secured. 

In certain conditions complete rest cannot be 
secured, except under the administration of mild opi- 
ates. These are as a rule objectionable on account of 
the fact that they have a tendency to check the secre- 
tions. 



— 128 — 

The best of the class, however (as there is less in- 
terference with the glandular action by the opiate in 
this form), is the Dover's powder, and the best form 
in which to administer the latter is the syrup-doveri 
(Gregory) in doses ranging from one-half to one tea- 
spoonful every two hours as may be required. This 
combination is pleasant and attractive to most chil- 
dren. 

There are times, however, when we can administer 
to good advantage infinitesimal doses of morphine, and 
the soluble triturates that have been prepared by the 
firm of Parke, Davis & Co. (Detroit), are very con- 
venient. 

We may take, for instance, a tablet of the one- 
eighth of a grain of morphine and dissolve it in twelve 
teaspoonfuls of water in a glass and we have there 
represented one-ninety-sixth of a grain of morphine 
to the teaspoonful. 

Instructions may be given to administer one tea- 
spoonful of this every half hour or every hour, as re- 
quired to secure rest. 

We should impress upon the attendants in the sick 
room the importance of guarding our patient against 
the meddlesome visiting and attention of over zeal- 
ous friends. 

The sick may well call out, "Save me from my 
friends." The attentions of the latter are well meant, 
but misdirected. 

A case of fever, as in fact any other disease, should 



— 129 — 

be managed on strictly business principles and a 
period of serious illness is no time for social visits, 
as they disturb, arouse and excite a sensitive patient, 
and interfere with the smooth running of the house- 
hold so essential to the comfort of the sufferer. 

Among the more intelligent class the securing of 
our wishes is easy, but the trouble comes in when we 
have our cases among the great numbers in the lower 
segment of the social circle. 

There the sick room is frequently crowded night 
and day, and it is important that we should be firm 
in our instructions, in fact, we should take a decided 
stand, informing the family that unless our instruc- 
tions are executed to the letter, we will retire from 
the case. 

Positiveness usually carries conviction, and a gene- 
ral commanding an army should never hesitate in his 
commands. Under such conditions suggestions are 
not in order. The thing to do is to command, and 
see that the command is obeyed. 



TYPHOID FEVER. 

Through the researches of Koch, Eberth, Meyer, 
Friedlaender, Gaffky, and later, of Fraenkel and 
Simonds, the typhoid bacillus has become an entity 
that must not (and cannot safely) be lost sight of 
during the progress of a case of typhoid fever and 
after its termination. 

We are too much inclined to be on the lookout for 
classical representations of this disease, as of many 
others. 

I have had a number that I placidly considered 
simple continued fever, temperature not ranging 
higher than from 101° to 103°, no rose spots, no 
tympanites, no special evidence of intestinal irrita- 
tion, nothing leading me to suspect typhoid fever, 
until suddenly aroused to an appreciation of the fact 
by dangerous and repeated hemorrhages from the 
bowel, and in one instance (in 1877) the bleeding con- 
tinued until it proved fatal. 

This occurred in a boy of six, and was convincing 
proof to me of the fallaciousness of the idea that 
formerly obtained that young children are not sus- 
ceptible to the malady. 

In this connection I recall the circumstance of a 
consultation upon a youth who had been ailing for 
some weeks, though he was up and about until a few 



— 131 — 

minutes before the family physician was summoned 
and found him in great agony. 

An investigation developed an intestinal perforation 
which caused death in a short time. 

The clinical history and the post-mortem revel- 
ations evidenced an illustration of "walking typhoid 
fever." 

We know that we frequently have scarlet fever so 
mild as to be entirely overlooked until the attention 
is aroused by grave nephritic trouble; and so in all 
diseases, the artistically perfect specimen is the excep- 
tion and not the rule. 

It has no doubt been the observation of all, that 
the course and complications of typhoid fever are as 
varied as the individual victims, but it was not re- 
cognized until lately (by Griesinger) that numerous 
light and rudimentary attacks (typhus levissimus) 
belonged to typhoid fever at all. 

They used to have all sorts of names applied to 
them, as suggested by Struempel, the favorite being 
"gastric fever." 

The diagnosis is of course difficult in proportion to 
the scanty development of typhoid symptoms, and 
it is best established by demonstrating an etiological 
relation between them and others that are plainly 
typhoid fever. 

Apropos to this middle class of cases, I remember 
a case that came under my observation some years 
ago; a five-year-old boy in a family where three 



— 132 — 

other cases developed (one fatal) of a violent charac- 
ter; the child was sick only about twenty-one days, 
and under ordinary circumstances his case would have 
been diagnosticated simple continued or remittent 
fever. 

As the individual manifestations vary, so too do 
entire epidemics. 

One season the type is violent, and in another mild. 

There are those who believe that by active inter- 
ference, typhoid fever may be aborted; though I am 
not ready to endorse this proposition, I am sure that 
it may be modified and abbreviated. 

I cite briefly the following as an illustration: 

July 21, 1887, J. T. C, taken with violent vomiting 
and intense abdominal pain; examination revealed a 
lusty plethoric boy, red tongue, heavily coated, pulse 
140 to the minute and full, temperature 105.5°, acute 
tenderness over abdomen with constipation. Reme- 
dies were ordered for opening the bowels, soothing 
the stomach, and reducing the temperature. 

After the lapse of twelve hours an action of the 
bowels had been secured, but there was no improve- 
ment in the general condition. 

One grain of calomel to be taken every hour, was 
ordered at once with the application of ten leeches 
over the stomach and ileo-coecal region at point of 
greatest tenderness, followed by hot fomentations. 

The leeches abstracted three or four ounces of 
blood, giving marked relief; at the end of ten hours 



— 133 — 

the ten grains of calomel had produced active purga- 
tion, and this together with, the local abstraction of 
blood, had mitigated all the symptoms; the temper- 
ature was down to 102°, the pain was almost gone 
no nausea, no vomiting. 

The patient was in every way more comfortable, 
and jogged along for four weeks with a mild form of 
typhoid fever instead of dying during the first five 
days, as I believe he would have done had a tempor- 
izing course been pursued. 

Recognizing the disease as an infectious one, de- 
pendent upon a specific virus, it behooves us to treat 
it upon the antiseptic plan, aiding elimination by 
stimulating the excretory organs, sustaining the 
strength by diffuse stimulation at the proper time, 
and the furnishing of an abundance of nutrition in a 
form for prompt assimilation. 

As previously remarked since the introduction of 
the coal tar products the dangers of high tempera- 
ture are much less than formerly, as we certainly can 
control that feature; however, I favor their very 
careful administration, until full opportunity is given 
for the ascertainment of the degree of susceptibility. 
There has been recorded already, a number of un- 
favorable results; even death has occurred owing 
probably to some peculiar idiosyncracy. I prefer 
small doses at short intervals, keeping up the effect 
continuously, rather than large doses which produce 
sudden and excessive falling of temperature. I think 



— 134 — 

a sudden reduction no matter bow attained, is not so 
likely to be maintained; large doses are depressing 
and endanger beart-failure. While tbe coal tar series 
are of great value as febrifuges and tranquilizers of 
the nervous system and at the same time diaphoretic, 
in the cooling bath we have an agent equally valu- 
able. I do not mean the sudden immersion in cold 
water; that is uncalled for, undesirable and brutal. 
The temperature of the water at first should be about 
the same as that of the patient, and may be gradually 
reduced to 85° to 80°. The bath may be prolonged 
five or ten minutes. Often, patients wildly delirious, 
go calmly to sleep during the progress of the bathing. 
The advantages of the bath I take it are: 

1. The reduction of temperature is accomplished 
gradually and comfortably to the patient in accord- 
ance with nature's plan of putting out fire with 
water: 

2. The water acts primarily as a soother of the 
peripheral nerves, and secondarilycalms the disturbed 
nerve centers: 

3. It stimulates the secretory glands, allays thirst 
by being directly absorbed into the heated and dry 
tissues; encourages diaphoresis as well as diuresis: 

4. It influences favorably the respiratory organs by 
energizing inspiration; and thus aids in the secur- 
ing of expectoration, and as a result bronchial com- 
plications are less frequent: 

5. The hygienic effect upon the skin is of great 



— 135 — 

value, removing as it does the foul smelling products 
of the sweat and sebaceous glands, aiding the pro- 
curement of strength and elasticity in the cutaneous 
and adjacent tissues, conditions antagonistic to bed- 
sores. 

The bath should be administered with due regard 
to the comfort of the patient; drafts should be avoided, 
and immediately following the bath a thorough dry- 
ing and brisk rubbing of the surface should be insti- 
tuted, and warm covering with hot water bag to the 
feet, if need be, and a nice cup of hot broth or a little 
wine or toddy would be in order. 

Acetanilid or phenacetin and bathing or sponging 
may be used conjointly to good advantage. . 

As an antipyretic, quinine should be ruled out alto- 
gether. In doses sufficiently large to reduce tem- 
perature, it is demoralizing to the nervous system as 
well as to the digestive tract, and when we recall the 
fact that the sheet anchor of hope in typhoid fever 
consists in good digestion and nutrition, and tranquil 
nerves, we can see that the objection to quinine is 
well founded. 

If well-defined malarial symptoms present them- 
selves as a complication, an antiperiodic is of course 
indicated, and quinine should be given, but very care- 
fully. 

In this connection permit me to express the opin- 
ion that the so-called typho-malarial fever of Wood- 
ward is a misnomer, being probably nothing more 



— 136 — 

than a modified expression of typhoid fever plus mal- 
aria. 

Certainly the coining of a new name for every 
modification of the disease is confusing, and the 
practice should receive no encouragement. 

What has been said above need not be interpreted 
as an objection to tonic doses of quinine during the 
period of convalescence, but as against the administra- 
tion of quinine to a well-defined case of typhoid fever. 

In the earlier, middle or later stages of the disease, 
there may come a time when the necessity of the 
situation demands the removal of the patient from 
one section of the country to another. 

I desire to place myself on record as being strongly 
of the opinion, that the danger of removing a person 
seriously sick has been greatly overrated ; that with 
due care, and guarding against the chilling of the 
surfaces and interruption of the proper amount of 
sleep, typhoid fever and other dangerous cases may 
be safely transported hundreds of miles. 

I have a record of four cases, successfully and ad- 
vantageously removed from one hundred to one thou- 
sand miles on sleeping cars, which justify this con- 
clusion. 

As the administration of the calomel purge in the 
beginning is satisfactory, so the renewal of one-eighth 
grain doses every other day to the number of half a 
dozen, is an advantage in the direction of keeping 
the bowels open, as well as serving as an intestinal 
antiseptic. 



— 137 — 

If an additional aid is required to evacuate the 
bowels an enema of a teaspoonful of glycerin (as 
suggested by Anacker) or the glycerin suppository is 
a ready means of securing a prompt evacuation. 

Permit me to emphasize the most salient points I 
desire to make: 

1. Typhoid fever varies in intensity, severity and 
length of attack, as do other infectious diseases, and 
while it has not yet been established that any of this 
class can be aborted, yet typhoid with all the others, 
may be mitigated and abbreviated, and unfortunate 
complications are sequelae often preventable: 

2. To the securing of this end that which is of 
paramount importance, is management rather than 
medication, though there are many dangers that can 
only be tided over by the prompt and proper exhibi- 
tion of drugs: 

3. The administration of remedies that are anti- 
septic and stimulate the excretory organs is impor- 
tant, and for this purpose small doses (1-50 gr.) of 
bichloride, or the mild chloride (1-8 to 1-4 gr.) as 
often as is necessary to produce the desired effect are 
of value: 

4. Nutrition, by the administration of food in a 
form for prompt assimilation, is a necessity, and to 
this end the diet should be limited to peptonized 
milk, beef peptones (Mosquero's Beef Cacoa) bovin- 
ine (Bush) etc., bearing in mind that the stereotyped 
home-made beef tea is of no more value as a food 



— 138 — 

than a weak toddy, being a mild stimulant and noth- 
ing more: 

5. Agreeable alcoholic stimulation furnishes food 
and force: 

6. Freedom from pain, tranquillity and perfect rest 
should be insisted upon, remembering that this dis- 
ease of all others has a wrecking effect upon the ner- 
vous system (it having been called by some German 
writers "fieber nervoese" or nervous fever) we 
should see to it that our patient obtains no less than 
twelve or sixteen hours sleep out of the twenty-four, 
and the remainder of the time be saved from the 
meddling, misdirected kindness of overzealous friends: 

7. For the obtaining of sleep and the relief of ner- 
vousness, the administration of acetanilide, phenace- 
tine, chloral, paraldehyde, urethan, and the bromides, 
is preferable to opiates, though occasionally the lat- 
ter are demanded: 

8. When the conditions surrounding a patient are 
unfavorable and a change is desirable, sometimes 
even to a distant point, the removal under proper 
precautions against chilling and unrest, may be per- 
mitted or even preferred, the danger of the same not 
being as great as it is generally considered to be: 

9. As a rule a patient with typhoid fever, or any 
other wasting disease, should not be permitted to 
have bed-sores, which are an expression of starved 
tissue and neglected skin, and are preventable, the 
means of their prevention being proper nutrition and 
bathing 1 . 



EPISTAXIS. 

Nose-bleed is a common occurrence among chil- 
dren. • It may be due to accident, by directly falling 
upon the nose, a denudation of the mucous membrane 
lining the nasal cavity, or the cause may be a general 
one, dependent upon blood pressure. To this class 
belongs the bleeding of the nose sometimes seen in 
the outset of active fevers. A special case of long 
continued bleeding from the nose is sometimes met 
with, but fortunately rarely, known as haemophilia, 
or the hemorrhagic diathesis, known among the 
laity as " bleeders ;" or the condition may be a con- 
stitutional one, a temporary tendency to ready haem- 
orrhage, due to some organic lesion of the blood. 
Under this head we have "purpura simple" "pur- 
pura hcemorrhagica " anaemia, chlorosis and the stru- 
mous diathesis. The bleeding from the nose of a 
child may be of very slight import, or it may indicate 
a serious condition. In the early stages of some of 
the acute diseases it may have a beneficial effect, but 
in all anaemic or weakened conditions of the blood, 
or in any case where it is prolonged, it bodes no good. 
We are frequently called to a sudden case of haemor- 
rhage from the nose in active and full-blooded chil- 
dren. In such cases generally we are safe in assur- 
ing the patient and the family that the bleeding 
will be beneficial rather than otherwise. If it does 



— 140 — 

not stop spontaneously, the application of ice-cold 
cloths over the nose and the frontal region of the 
head may be sufficient. If not, the introduction into 
the nares of small pledgets of ice and the snuffling 
up of ice- water, will serve the purpose. It may be 
desirable to saturate the same with alum. If the 
conditions be such as to demand a prompt checking 
of the haemorrhage, the introduction into the inte- 
rior part of the nose by means of a long slender probe, 
of small pledgets of absorbent lint, tied at intervals 
of two or three inches upon oiled silk thread, the 
pledgets being about half an inch square, and satu- 
rated with a strong solution of alum, or smeared with 
pulverized tannin, and the same packed firmly, 
though gently, into the entire anterior nasal space, 
may be all sufficient. Sometimes, however, the 
bleeding may be active, and be in the direction of 
the back part of the nose, and require a plugging of 
the posterior nares. In this case there are instru- 
ments which have been devised, to the point of which 
may be applied, attached to a string, sponges satu- 
rated with astringents, such as the sesqui-chloride 
of iron, tannin or alum. A most valuable means 
which I have applied during the past twenty years to 
the posterior nares, suggested to me when a student 
by my esteemed teacher and friend, the late Prof. 
Jno. J. McDowell of St Louis, and which I have 
never seen recorded, is the use of the condom, which 
is made from the animal membrane known as the 



— 141 — 

" vermiform appendix " of the sheep, and sold in the 
majority of drug stores ; or, has been presented to us 
in these latter days, in the form of the delicate, 
finest quality of soft india rubber. The sizes vary. 
I would select one in accordance with the age. For 
a child the smallest size would be valuable. By 
means of a long and delicate probe introduced within 
the condom, it can be pushed gently upward and 
backward through whichever nostril seems to be the 
most open ; and in this connection we must remem- 
ber that in nearly all cases there is a deviation of the 
septum, so that one nostril or the other is the smaller. 
By gently pushing the probe, which is embraced by 
the condom, upward and backward, the probe being a 
pliable one, which can be bent in accordance with the 
necessities, we soon have it reaching well back in the 
naso-pharyngeal space. The condom can then be read- 
ily filled with ice-water, and we can have a ligature at 
the external opening, which can be closed at will. 
By this means we have a cold mass and pressure in 
back part of the nose, which in the majority of cases 
promptly checks the haemorrhage. I have rarely 
found this procedure fail, and it is unquestionably 
easier of application than the average "plugger," 
and is much more portable, as the condom can be 
carried in the purse easily. When one succeeds in 
checking the haemorrhage, as I believe he will, he 
may felicitate himself that he has done the work "se- 
cundum artem." 



Pepsin in Infantile Diarrhoea. 

Statistics show that the mortality rate of infantile diar- 
rhoea, as it manifests itself in the summer months, is higher 
than that of any other disease. 

How shall the conditions present best be met? To answer 
this query has inspired exhaustive contributions from the pens 
of our most learned medical writers. It is admitted by all 
that one of the causes which incites and perpetuates the gas- 
tric and intestinal inflammation is undigested, or partly di- 
gested, fermenting milk or other food, the decomposition of 
which is accompanied by the development of ptomaines and 
other toxic principles. It is as an aid to the removal of this 
cause, both in predigesting milk or other food before it is 
given, and in digesting fermented undigested food in the 
stomach, that pepsin is indicated in infantile diarrhoea, and its 
efficacy has been attested by many well-known medical writers. 
(See /. Lewis Smith, M. D., Archives of Pediatrics, Sept., '86, 
p. 518; Nov., '86, p. 639; Nov., '64, p. 424. Prof. Vocher, of 
Berlin Archiv. f. Kinder h, vol. p, p. 3. Dr. I. N. Love, St. 
Louis Weekly Medical Review, Aug., '88. T. Lauder Brunton, 
Diseases of Digestion, p. 2pi. A. Holt, N. Y. Archiv. Pedia- 
trics, 1886, p. 732. A. G. Bigelow, Archiv. Pediatrics, 1884, p 
430. Discussion at German Medical Congress, at Salzburg, 1881, 
by Biedert, Gerhart, Henoch, Steffen, Thomas, Soltman, Pfeiffer. 
Prof. Leeds, Archiv. Ped., 1884, p. 421, etc.) 

We supply pepsin in the following forms: 

Pepsinum Purum in Lamellis ; Pepsinum Purum 
Pulvis; Pepsin, Saccharated, U. S. P., 1880; Pepsin, 
Glycerole, Concentrated ; Pepsin, Lactated ; Pepsin 
Liquid, U. S. P., 1880 ; Pepsinum Purum Tablets, 1 
gr., Sugar-Coated ; Pepsin Cordial. 

All information desired by physicians as to our pepsin 
products, our general line of standard medicinal preparations, 
pharmaceutical specialties, and latest therapeutic novelties and 
improvements in methods of medication, will be promptly fur- 
nished on request. 

PARKE, DAVIS & CO., 

DETROIT AND NEW YORK 



£U£)E)ETm e* PUBLICATION 

— OF — 

GEORGE S. DAYIS, Publisher. 

THE THERAPEUTIC GAZETTE. 

A. Monthly Journal of Physiological and. Clinical Therapeutics. 

EDITED BY 

33,0333333,37 3VE33.A-3D33 S3VT.I3733:, 3VL. 3D. 

SUBSCRIPTION PRICE, $2.00 PER YEAR. 

THE INDEX MEDICUS. 

A Monthly Classified Record of the Current Medical Literature of the World. 

COMPILED UNDER THE DIRECTION OF 

DR. JOHN S. BILLINGS, Surgeon U. S. A., 

and DR. ROBERT FLETCHER, M. R. C. S., Eng. 

SUBSCRIPTION PRICE, $ 1 0.OO PER YEAR. 
THE AMERICAN LANCET. 

EDITED BY "• 

XjIE-A-IRT-U-S COJSnCsTOH, 3vE. 3D. 
A MONTHLY JOURNAL DEVOTED TO REGULAR MEDICINE. 
SUBSCRIPTION PRICE, $2.00 PER YEAR. 

THE MEDICAL, AGE. 

EDITED BY 

33. "W. 3?^.313\>C3333., -A_. 3\E., 3v£. 3D. 

A Semi-Monthly Journal of Practical Medicine and Medical News. 

SUBSCRIPTION PRICE, $1.00 PER YEAR. 

THE WESTERN MEDICAL. REPORTER. 

EDITED BY 

CT. 33. 331^.33,333333,, -A-. 3v£., 3v£. 3D. 

A MONTHLY EPITOME OF MEDICAL PROGRESS. 

SUBSCRIPTION PRICE, $I.OO PER YEAR. 

THE BULLETIN OP PHARMACY. 

EDITED BY 

33. "W- 33^3^3x013333, -A-. 3\£., 3VC- 3D. 

A Monthly Exponent of Pharmaceutical Progress and News. 

SUBSCRIPTION PRICE, $1.00 /\ YEAR. 



New subscribers taking more than one journal, and accompanying subscription 
by remittance, are entitled to the following special rates. 

GAZETTE and AGE, $2.50 ; GAZETTE, AGE and LANCET. $4.00 ; LANCET 
and AGE, $2.50 ; WESTERN MEDICAL REPORTER or BULLETIN with any of 
the above at 20 per cent, less than regular rates. 

Combined, these journals furnish a complete working library of current medi- 
cal literature. All the medical news, and full reports of medical progress. 



GEO. S. DAYIS, Publisher, Detroit, Mich, 



IN EXPLANATION 



OF 



Tie Physicians' Leisure Library. 

We have made a new departure in the publication of medical books. As you 
no doubt know, many of the large treatises published, which sell for four or five or 
more dollars, contain much irrelevant matter of no practical value to the physi- 
cian, and their high price makes it often impossible for the average practitioner to 
purchase anything like a complete library. 

Behoving that short practical treatises, prepared by well known authors, con- 
taining the gist of what they had to say regarding the treatment of diseases com- 
monly met with, and of which they had made a special study, sold at a small price, 
would be welcomed by the majority of the profession, we have arranged for the 
publication of such a series, calling it The Physicians' Leisure Library. 

This series has met with the approval and appreciation of the medical profes- 
sion, and we shall continue to issue in it books by eminent authors of this country 
and Europe, covering the best modern treatment of prevalent diseases. 

The series will certainly afford practitioners and students an opportunity 
never before presented for obtaining a working library of books by the best authors 
at a price which places them within the reach of all. The books are amply illus- 
trated, and issued in attractive form. 

They may be had bound, either in durable paper covers at 25 Cts. per copy, 
or in cloth at 50 Cts. per copy. Complete series of 12 books in sets as announced, 
at $2.50, in paper, or cloth at $5.00, postage prepaid. See complete list. 



PHYSICIANS' LEISURE LIBRARY 



PRICE: PAPER, 25 CTS. PER COPY, $2.50 PER SET; CLOTH, 50 CTS. PER COPY, 
$5.00 PER SET. 



SERIES I. 



Inhalersi Inhalations and Inhalants. 
By Beverley Robinson, M. D. 

The Use of Electricity in the Removal of 
Superfluous Hair and the Treatment of 
Various Facial Blemishes. 
By Geo. Henry Fox, M. D. 

New Medications, Vol. I. 

By Dujardin-Beaumetz, M. D. 

New Medicationsi Vol. II. 

By Dujardin-Beaumetz, M. D. 

The Modern Treatment of Ear Diseases. 
By Samuel Sexton, M. D. 

The Modern Treatment of Eczema. 
By Henry G. Piffard, M. D. 



Antiseptic Midwifery. 

By Henry J. Garrigues, M. D. 
On the Determination of the Necessity for 
Wearing Glasses. 

By D. B. St. John Roosa, M. D. 
The Physiological, Pathological and Ther- 
apeutic Effects of Compressed Air. 

By Andrew H . Smith, M. D. 
GranularLids and ContagiousOphthalmia. 

By W. F. Mittendorf, M. D. 
Practical Bacteriology. 

ByThomas E. Satterthwaite, M D. 
Pregnancy, Parturition, the Puerperal 
State and their Complications. 

By Paul F. Munde, M. D. 



SERIES II. 



The Diagnosis and Treatment of Haem- 
orrhoids 

By Chas. B. Kelsey, M. D. 
Diseases of the Heart, Vol. I. 

By Dujardin-Beaumetz, M. D. 
Diseases of the Heart, Vol. II. 

By Dujardin-Beaumetz M. D. 
The Modern Treatment of Diarrhoea and 
Dysentery. 

By A. B. Palmer, M. D. 
Intestinal Diseases of Children, Vol. I. 

By A. Jacobi, M. D. 
Intestinal Diseases of Children, Vol. II. 

By A. Jacobi, M. D. 



The Modern Treatment of Headaches. 
By Allan McLane Hamilton, M. D. 

The Modern Treatment of Pleurisy and 
Pneumonia. 

By G. M. Garland, M. D. 
Diseases of the Male Urethra. 

By Fessenden N. Otis, M. D. 
The Disorders of Menstruation. 

By Edward W. Jenks, M. D. 
The Infectious Diseases, Vol. I. 

By Karl Liebermeister. 

The Infectious Diseases, Vol. II. 
By Karl Liebermeister. 



SERIES III. 



Abdominal Surgery. 

By Hal C. Wyman, M. D. 

Diseases of the Liver- 

By Dujardin-Beaumetz, M. 

Hysteria and Epilepsy. 

By J. Leonard Corning, M. 

Diseases of the Kidney. 

By Dujardin-Beaumetz, M. 



D. 



The Theory and Practice of the Ophthal- 
moscope. 

By J. Herbert Claiborne, Jr., M. D. 

Modern Treatment of Bright's Disease. 
By Alfred L. Loomis, M. D. 



Clinical Lectures on Certain Diseases of 
Nervous System. 

By Prof. J. M. Charcot, M. D. 
The Radical Cure of Hernia. 

By Henry O. Marcy, A. M., M. D., 

Spinal Irritation. 

By William A. Hammond, M. D. 
Dyspepsia. 

By Frank Woodbury, M. D. 
The Treatment of the Morphia Habit. 

By Erlenmeyer. 
The Etiology, Diagnosis and Therapy of 
Tuberculosis. 

By Prof. H. von Ziemssen. 



SERIES rtf. 



Nervous Syphilis. 

By H. C. Wood, M. D. 

Education and Culture as correlatedHo 
the Health and Diseases of Women. 
By A. J. C. Skene, M. D. 

Diabetes. _ 

By A. H. Smith, M. D. 

A Treatise on Fractures. 

By Armand Despres, M. D. 
Some Major and Minor Fallacies concern- 
ingSyphilis. 

By E. L. Keyes, M .D. 
Hypodermic Medication. 

By Bourneville and Bricon. 



Practical Points in the Management of 
Diseases of Children. 
By I. N. Love, M. D. 

Neuralgia. 

By E. P. Hurd, M. D. 

Rheumatism and Gout. 

By F. Le Roy Satterlee, M. D. 
Electricity, Its Application in Med'cinei 

By Wellington Adams, M.D. [Vol.1] 
Electricity, Its Application In Medicine. 

By Wellington Adams, M.D. [Vol.II] 
Auscultation and Percussion. 

Ky Frederick C. Shattuck, M. D. 



SERIES IT. 



Taking Cold. 

By F. W. Bosworth, M. D. 

Practical Notes on Urinary Analy- 
sis. 

By William B. Canfield, M. D. 

Practical Intestinal Surgery. Voi.i. 
Practical Intestinal Surgery. Voi.il. 

By F. B. Robinson, M. D. 
Lectures on Tumors. 

By John B. Hamilton, M. D., LL. D. 

Pulmonary Consumption, a Ner- 
vous Disease. 

By Thomas J . Mays, M . D . 

Lessons In the Diagnosis and 
Treatment of Eye Diseases. 
By Casey A. Wood, M. D. 



Diseases of the Bladder and Pros- 
tate. 

By Hal C. Wyman, M. D. 

Artificial Anaesthesia and Anaes- 
thetics. 

By DeForest Willard, M. D., and Dr. 
Lewis H. Adler, Jr. 

Cancer. 

By Daniel Lewis, M. D. 

The Modern Treatment of Hip Dis- 
ease. 

By Charles F. Stillman, M. D. 

Insomnia and Hypnotics. 

By Germain See. 

Translated by E. P. Hurd, M. D. 



BOOKS BT LEADING AUTHORS. 

SEXUAL IMPOTENCE IN MALE AND FEMALE $3.00 

By Wm. A. Hammond, M. D. 
PHYSICIANS' PERFECT VISITING LIST 1.50 

By G. Archie Stockwell, M. D. 
A NEW TREATMENT OF CHRONIC METRITIS 50 

By Dr. Georges Apostoli. 
CLINICAL THERAPEUTICS 4.00 

By Dujardin-Beaumetz, M. D. 
MICROSCOPICAL DIAGNOSIS 4.00 

By Prof. Chas. H. Stowell, M. S. 
PALATABLE PRESCRIBING 1.00 

By B. W. Palmer, A. M., M. D. 
UNTOWARD EFFECTS OF DRUGS 2.00 

By L. Lewin, M. D. 
SANITARY SUGGESTIONS (Paper) 25 

By B. W. Palmer, M. D. 
SELECT EXTRA-TROPICAL PLANTS 3-o© 

By Baron Ferd. von Mueller, 
TABLES FOR DOCTOR AND DRUGGIST 2.00 

By Eli H. Long, M. D. 



GEORGE S. DAVIS, Publisher, 

O. B022: 470 Detroit, ^CIcl^ 



LIBRARY OF CONGRESS 




022 169 352 8 






m 11 







